Differences in the Quality of Pediatric Resuscitative Care Across a Spectrum of Emergency Departments

作者：Auerbach Marc; Whitfill Travis; Gawel Marcie; Kessler David; Walsh Barbara; Gangadharan Sandeep; Hamilton Melinda Fiedor; Schultz Brian; Nishisaki Akira; Tay Khoon Yen; Lavoie Megan; Katznelson Jessica; Dudas Robert; Baird Janette; Nadkarni Vinay; Brown Linda

来源：JAMA Pediatrics, 2016, 170(10): 987-994.

DOI：10.1001/jamapediatrics.2016.1550

IMPORTANCE The quality of pediatric resuscitative care delivered across the spectrum of emergency departments (EDs) in the United States is poorly described. In a recent study, more than 4000 EDs completed the Pediatric Readiness Survey (PRS); however, the correlation of PRS scores with the quality of simulated or real patient care has not been described.
OBJECTIVE To measure and compare the quality of resuscitative care delivered to simulated pediatric patients across a spectrum of EDs and to examine the correlation of PRS scores with quality measures.
DESIGN, SETTING, AND PARTICIPANTS This prospective multicenter cohort study evaluated 58 interprofessional teams in their native pediatric or general ED resuscitation bays caring for a series of 3 simulated critically ill patients (sepsis, seizure, and cardiac arrest).
MAIN OUTCOMES AND MEASURES A composite quality score (CQS) was measured as the sum of 4 domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. Pediatric Readiness Survey scores and health care professional demographics were collected as independent data. Correlations were explored between CQS and individual domain scores with PRS.
RESULTS Overall, 58 teams from 30 hospitals participated (8 pediatric EDs [PEDs], 22 general EDs [GEDs]). The mean CQS was 71 (95% CI, 68-75); PEDs had a higher mean CQS (82; 95% CI, 79-85) vs GEDs (66; 95% CI, 63-69) and outperformed GEDs in all domains. However, when using generalized estimating equations to estimate CQS controlling for clustering of the data, PED status did not explain a higher CQS (beta = 4.28; 95% CI, -4.58 to 13.13) while the log of pediatric patient volume did explain a higher CQS (beta = 9.57; 95% CI, 2.64-16.49). The correlation of CQS to PRS was moderate (r = 0.51; P < .001). The correlation was weak for cardiac arrest (r = 0.24; P = .07), weak for sepsis (rho = 0.45; P < .001) and seizure (rho = 0.43; P = .001), and strong for teamwork (rho = 0.71; P < .001).
CONCLUSIONS AND RELEVANCE This multicenter study noted significant differences in the quality of simulated pediatric resuscitative care across a spectrum of EDs. The CQS was higher in PEDs compared with GEDs. However, when controlling for pediatric patient volume and other variables in a multivariable model, PED status does not explain a higher CQS while pediatric patient volume does. The correlation of the PRS was moderate for simulation-based measures of quality.

• 出版日期2016-10