Dell Children’s Medical Center of Central Texas and the 10 other Ascension hospitals in Central Texas are participating in a national collaborative program to improve the care of children in emergency departments, particular those emergency rooms that are not in a children’s hospital.
The Pediatric Readiness Quality Collaborative launched in January and will run through December 2019.
The collaborative is a response to a national 2013 Emergency Medical Services for Children Program study that found that 80 percent of emergency departments were not prepared to treat children in a uniform way. That program found that 69.4 percent of the 30 million children who go to the emergency room every year are treated by emergency departments that treat fewer than 15 children a day.
That study found key areas in which emergency departments weren’t ready for children:
- Children were not weighed in kilograms, which can impact the proper dosing of medication.
- A full set of vital signs including blood pressure, temperature and mental illness assessment weren’t being done. Doctors were missing when children had abnormal vital signs.
- Hospital systems didn’t have guidelines for when and how to transfer pediatric patients to a higher level hospital.
- Disaster plans didn’t include children, who could come into an emergency department without a guardian, identification or the verbal ability to say what is wrong.
Dell Children’s already had been working on improving emergency department care at some of Ascension’s Central Texas Facilities. It added Dell Children’s-branded emergency rooms at Seton Northwest Hospital, Seton Southwest Hospital, Seton Medical Center Hays in Kyle, Seton Medical Center Williamson in Round Rock and Providence Healthcare Network in Waco.
“The real goal for us is to prepare for all hospitals to handle children,” said Dr. Sujit Iyer, assistant medical director at Dell Children’s emergency department and director of pediatric emergency department outreach.
Dr. Katherine Remick is one of the executive leads for the national Emergency Medical Service for Children Innovation and Improvement Center and the director of this collaborative, which Dell Children’s applied to be a participant.
Remick, who is also a doctor at Dell Children’s, says if her child was child choking and she lived outside of Austin, she’s not going to drive 45 minutes to Dell Children’s. She’s going to go to whatever emergency department is close and hope they are ready for her child. “Without the presence of preparedness efforts, most emergency departments are not ready for that child,” she says.
People think of preparedness in terms of disasters, she says, but what this project is about an emergency room being able to treat one child.
“Children have unique risks,” she says. “These include differences in anatomy and physiology.”
Being prepared is about training and about having the right equipment and supplies that are child-sized, but it’s also about having someone who is looking at quality control for children, Remick says. “It’s about having someone who is putting children on their radar,” she says.
To be part of the study, Iyer says, all the management of the Ascension hospitals in Central Texas had to sign off on it and be interested in improving care. Each of them also now have someone trained to be a pediatric care coordinator.
Once all the data is collected from participating hospitals around the country, the hope is that they will share best practices and note that these efforts improve outcomes in the care of children, Remick says.