Pediatric emergency medicine trisk 17
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Section VII: Behavioral Health Emergencies
126
Behavioral and Psychiatric Emergencies
Emily R. Katz, Anik Jhonsa, Eron Friedlaender, Joel A. Fein, Thomas H. Chun,
Laura L. Chapman
127
Sexual Assault: Child and Adolescent
Jennifer Molnar, Megan Schluckebier O’Connell, Cynthia Mollen, Philip Scribano
Section VIII: Procedures and Appendices
128
Equipment
Caleb E. Ward, Dewesh Agrawal
129
Procedural Sedation
Jeannine Del Pizzo, Joel A. Fein, Steven M. Selbst
130
Procedures
Theresa M. Frey, Matthew R. Mittiga
131
Ultrasound
Jason Levy, Joanna S. Cohen, Alyssa Abo, Rachel G. Rempell, J. Kate Deanehan
132
Biological and Chemical Terrorism
Richard J. Scarfone, James M. Madsen, Theodore J. Cieslak, Edward M. Eitzen Jr.
133
Instructions for Parents
Hilary A. Hewes, Nanette C. Dudley
134
Prehospital Care
Toni K. Gross, Theresa A. Walls, George A. (Tony) Woodward
135
Technology-Assisted Children
Ellen G. Szydlowski, Kathleen M. Cronan, Joel A. Fein, Jill C. Posner
Index
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SECTION I
Core Principles of Quality and Safety
CHAPTER 1 ■ INTRODUCTION: HIGHQUALITY EMERGENCY CARE FOR
CHILDREN
KATHY N. SHAW, RICHARD G. BACHUR
GOALS OF EMERGENCY CARE
Our primary goal as practitioners is to provide high-quality, safe care for
each child who arrives in our emergency department. The ability to stay
current with knowledge and clinical skills across all possible conditions is
impossible for any clinician. Furthermore, the evidence may be poor,
inconsistent, or changing for the management of many diseases or injuries.
This leads to a wide variation in practice, high rates of inappropriate care,
patient harm, and wasted resources. Additionally, the model of optimal care
in emergency departments is challenged by high acuity and crowding that
demands teamwork, resources, a well-structured quality program, and a
culture of high reliability. With this new edition of the Textbook of Pediatric
Emergency Medicine , we provide easy web-based access for use in practice,
links to clinical pathways based on the latest evidence and expert consensus,
and a new, streamlined format that emphasizes the goals of quality care.
KEY POINTS
Standardization of care by using evidence-based clinical pathways
or guidelines reduces variation in practice and decreases the rates
of inappropriate care for children.
Easily accessed web-based resources aid clinicians in reducing
medical errors due to cognition.
Teamwork, communication, and a nonpunitive reporting
environment are key to providing safe care for children in EDs.
Both the systems at the “blunt end” and the practices of the
clinicians at the “sharp” end must be consistently monitored and
improved to provide highly reliable care.
Beyond evidence and expert consensus, optimal health care also
requires a humanistic approach which includes compassion,
collaboration with the patient and family, attention to the health
care experience, and patient-reported outcomes.
QUALITY AND ITS MEASUREMENT IN PEDIATRIC
EMERGENCY MEDICINE
KEY POINTS
Pediatric Quality Improvement Coordinators and Committees are
essential to providing safe care for children in EDs.
Monitoring pediatric indicators across the six domains of quality
and instituting improvement when needed are essential to
providing the highest value and safest care for children in our EDs.
Current Evidence and Practice
The quality and safety of pediatric emergency medicine vary widely. In
addition to unexplained variations in care related to individual providers and
hospitals, there is likely a bimodal relationship between volume and quality.
In other words, providers in EDs where pediatric volumes are low may lack
familiarity with pediatric diseases and may also lack needed experienced
clinical team members, processes, basic equipment, and supplies to care for
children. In contrast, overcrowding in EDs with very high pediatric volumes
