Abstract:
OBJECTIVE:Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METHODS:Our multidisciplinary team identified key contributing factors to timeliness, developed key driver diagrams, implemented and refined a management pathway, designed and executed rapid cycle improvements, and implemented interventions. A time series design was used to analyze outcomes with baseline data and continuous monitoring during active intervention steps. The primary outcomes analyzed were the times to first β-agonist and steroid administration. Secondary outcomes included admission rate, ED length of stay, and ED revisits. RESULTS:Assignment of the Pediatric Asthma Score, our initial pathway step, occurred in most patients within the first several months. Time to first β-agonist administration decreased from the baseline mean of 76 minutes to 27 minutes. Time to steroid administration decreased from the baseline mean of 108 minutes to 49 minutes. Mean monthly admission rate remained at 22% with no special cause variation identified. The ED revisit rate was not negatively impacted and, in most months, was 0%. CONCLUSIONS:By standardizing asthma care in our ED and redesigning care delivery processes, care variation decreased and significant improvements in timeliness of β-agonist and steroid administration occurred.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
McIver M,Stoudemire W,Smith-Ramsey C,Panigrahi M,Walsh-Kelly C,Rutman LEdoi
10.1097/PEC.0000000000001249subject
Has Abstractpub_date
2017-09-01 00:00:00pages
635-642issue
9eissn
0749-5161issn
1535-1815journal_volume
33pub_type
杂志文章abstract:OBJECTIVE:Documentation of use of octylcyanoacrylate adhesives in a pediatric emergency department with reference to patient selection, complications, and parent satisfaction. DESIGN:Retrospective and concurrent chart review of the first 100 patients on which 2-octylcyanoacrylate (2-OCA, Dermabonda) was used in a pedi...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200010000-00005
更新日期:2000-10-01 00:00:00
abstract::Serious intra-abdominal injuries in neonates are very rare. In addition, the signs and symptoms of hemoperitoneum caused by bleeding from solid viscera are vague and nonspecific and often are not recognized before the onset of hypovolemic shock or death. In this report, we describe a 2-day-old infant who presented wit...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-200002000-00009
更新日期:2000-02-01 00:00:00
abstract::The unique characteristics of the pediatric population expose them to errors in the emergency department (ED) with few standard practices for the safety of care. Young children and high-acuity patients are at increased risk of adverse events both in the prehospital and ED settings. We provide an overview of the proble...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000278393.32752.9f
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the patterns of ceftriaxone use in an urban pediatric emergency department (PED) and to determine if overuse exists based on published guidelines for management of febrile infants. METHODS:We conducted a retrospective study of 229 young febrile patients who received ceftriaxone between January 1 ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200208000-00007
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVES:We hypothesized that the use of ultrasound guidance would improve the success rate of peripheral intravenous catheter placement in pediatric patients with difficult access in a pediatric emergency department (ED). Our secondary hypotheses were that ultrasound guidance would reduce the number of attempts, the...
journal_title:Pediatric emergency care
pub_type: 杂志文章,随机对照试验
doi:10.1097/PEC.0b013e31819a8946
更新日期:2009-03-01 00:00:00
abstract::Rhabdomyosarcoma is the most common soft tissue tumor of childhood, frequently presenting in the head and neck, genitourinary tract, or extremities. We present a case of rhabdomyosarcoma in which an 18-year-old woman presented with abrupt onset unilateral hearing loss, tinnitus, dysarthria, dysphagia, and a new painle...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181b0a482
更新日期:2009-08-01 00:00:00
abstract::Forty-three nonhemophiliac, confirmed HIV-positive children followed by the Children's Hospital AIDS Program made 184 visits to the children's Emergency Department (ED) during 1988 and 1989. The mean age was 30 +/- 28 months with a median of 25 months, a mode of 10 months, and a range from two days to 19 years. CD4 co...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199310000-00002
更新日期:1993-10-01 00:00:00
abstract::The development of leadership and management skills requires a commitment to personal introspection and the development of self-knowledge. Difficult decisions concerning the determination of that which is truly important is central to the process. At both the personal and organizational levels, this process can be fac...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-199506000-00014
更新日期:1995-06-01 00:00:00
abstract::Sledding injuries are a common wintertime problem. To better characterize these injuries, three analyses were done: a retrospective chart review of all injured sledders at St. Louis Children's Hospital (SLCH) in the winter of 1990-91, a review of Consumer Product Safety Commission (CPSC) injury data for 1990, and meas...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199306000-00011
更新日期:1993-06-01 00:00:00
abstract:OBJECTIVE:Outcomes of emergency care delivered to children vary by patient-level socioeconomic factors and by emergency department (ED) characteristics, including pediatric volume. How these factors intersect in emergency care-seeking patterns among children is not well understood. The objective of this study was to ch...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002244
更新日期:2020-09-16 00:00:00
abstract:OBJECTIVES:Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival. METHODS:We performed a...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001072
更新日期:2019-06-01 00:00:00
abstract::A case of albuterol abuse by a pediatric patient with the development of hypokalemia with electrocardiographic changes is presented. The hypokalemic effects of beta2-agonists are discussed in regard to the production of significant cardiac symptoms. Additionally, guidance regarding the evaluation of similar patients p...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199804000-00015
更新日期:1998-04-01 00:00:00
abstract::A study was carried out to determine the influence of telemedicine on management of facial lacerations in children. Proforma was designed, and information was collected retrospectively over a 4-month period. Of the 2524 telemedicine referrals, 27% (693/2524) were pediatric referrals. One hundred forty-five of these we...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31829ec25c
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:There is little literature describing the performance of video laryngoscopes for the intubation of pediatric patients in the emergency department (ED). The purpose of this study is to report our experience with direct laryngoscopy (DL), the C-MAC (CMAC), and the GlideScope (GVL) over a 10-year period in an ur...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001911
更新日期:2019-09-09 00:00:00
abstract:OBJECTIVES:In 1997, a Canadian task force published evidence-based guidelines for diagnosing pediatric pneumonia, concluding that the absence of each of four signs (ie, respiratory distress, tachypnea, crackles, and decreased breath sounds) accurately excludes pneumonia. The study was performed to evaluate the accuracy...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200108000-00003
更新日期:2001-08-01 00:00:00
abstract::Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pa...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198706000-00015
更新日期:1987-06-01 00:00:00
abstract:OBJECTIVE:The objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance. METHODS:This was...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31828503ea
更新日期:2013-03-01 00:00:00
abstract::Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple systems, and its various symptoms are often mistaken for other diseases. This case report describes a 15-year-old girl who presented to the emergency department with complaints of diffuse abdominal pain, facial swelling, joint pain, low-gra...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001066
更新日期:2019-01-01 00:00:00
abstract::Foreign body ingestion is a common occurrence in children. Morbidity associated with ingestion is rare and is dependent on the type of foreign body ingested. We report a case of a 9-year-old boy who developed intestinal obstruction and perforation following ingestion of magnetic-backed earrings. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000134926.03030.a7
更新日期:2004-07-01 00:00:00
abstract::This article reviews the mechanisms of pulmonary injury associated with smoke inhalation and the pathophysiology of carbon monoxide poisoning. In addition, the temporal stages of pulmonary injury and evaluation and treatment of the pediatric patient are discussed. Maintaining a high index of suspicion when treating th...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198603000-00010
更新日期:1986-03-01 00:00:00
abstract::Many of the causes of complaints can be reduced but not completely eliminated. Appropriate attention through education and quality management keeps the department's attention focused on increasing patient satisfaction. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-199404000-00009
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVES:Fever in young infants frequently triggers a laboratory evaluation because of the increased likelihood of serious bacterial infections. Reported fever by methods other than rectal thermometry is of concern. This study evaluates the validity of perceived, pacifier, and temporal artery (TA) temperatures. METH...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000086231.54586.15
更新日期:2003-08-01 00:00:00
abstract::Ultrasonography can be useful in the evaluation of children with abdominal complaints and may be the initial imaging modality in patients presenting with a newly recognized abdominal mass. Hepatoblastoma is an uncommon cause of acute abdominal pain in children and can rarely metastasize to the heart through vascular i...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001629
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:Each day, children incur more than 69,000 emergency department (ED) visits, with 58% to 82% of them for nonurgent reasons. The objectives of this study were to elicit and to describe guardians' and health professionals' opinions on reasons for nonurgent pediatric ED visits. METHODS:Focus groups sessions were...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318248b431
更新日期:2012-03-01 00:00:00
abstract::We retrospectively reviewed the emergency department records of 77 children and adolescents seen in an emergency department with the chief complaint of fainting. Upon careful review, 20 patients had not had any type of syncopal or near-syncopal episode. Of the remaining 57 patients, 40 experienced syncope, and 17 pati...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198906000-00002
更新日期:1989-06-01 00:00:00
abstract::Vertebral artery dissection is an unusual cause of stroke especially in children. The majority of dissections are thought to be caused by trauma although in many cases the trauma may be trivial. In other cases, certain underlying pathological processes are thought to be risk factors. We report a case of vertebral arte...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200006000-00014
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVES:The Accreditation Council for Graduate Medical Education requires pediatric residency training programs to provide exposure to the prehospital management and transport of patients. The authors hypothesized that compared with a similar study a decade prior, current pediatric residency training programs have r...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31823ed4ab
更新日期:2012-01-01 00:00:00
abstract::Pneumocephalus or air within the cranial vault is usually associated with disruption of the skull caused by head trauma, neoplasms, or after craniofacial surgical interventions. We report a child who presented with headache and the pathognomonic "succussion splash" and was found to have atraumatic pneumocephalus from ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:
更新日期:1999-04-01 00:00:00
abstract::Chronic hematomas are defined as hematomas with slow, progressive growth over many weeks. They are an extremely rare cause of acute neck swelling in the pediatric population. They consist of an organized central mass of blood with granulation tissue and fibrotic changes peripherally. The presence of a capsule prevents...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001402
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To obtain social and cultural data about factors affecting the development of Emergency Medical Services for Children (EMS-C) in La Paz, Bolivia. The points-of-view of potential consumers and providers were sought. METHODS:A Rapid Assessment Procedure (RAP) was conducted. RAP is a qualitative ethnographic te...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000142950.58265.15
更新日期:2004-10-01 00:00:00