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Pediatric training essential to improving out-of-hospital emergency care for children

Study shows factors contributing to pediatric patient safety in the out-of-hospital setting differ significantly from hospital-based care
August 18, 2015

PORTLAND, Ore.– A national survey of more than 750 emergency medical services providers conducted by researchers at Oregon Health & Science University identified airway management skills, personal anxiety and limited pediatric care proficiency among key factors that may contribute to pediatric safety events for children in out-of-hospital emergent care situations. The study, published online today in The Journal of Pediatrics, supports the American Academy of Pediatrics' recommendation for pediatric physician involvement in EMS training, medical oversight and policy development.

"Pediatric care merits specialized attention because of its unique challenges, including age-dependent anatomic differences, varied medication dosing and size-based equipment needs,” said the study's lead researcher Jeanne-Marie Guise, M.D., M.P.H., professor of obstetrics and gynecology, and emergency medicine, in the OHSU School of Medicine. "Understanding and properly reacting to these factors, as well as providing training for all health care providers, is pivotal not only to preventing medical errors in pediatric cases, but also in strengthening health care delivery across the United States.”

To conduct the research, Guise and colleagues used a structured group interaction process known as the Delphi method, to achieve unbiased consensus from participants representing 44 states, making it one of the largest nationwide surveys of its kind. Qualitative and quantitative analyses of responses were conducted to identify the factors perceived as most and least likely to lead to pediatric safety events.

From an initial set of 150 potential contributing factors, survey respondents also perceived lack of experience with pediatric equipment, as well as the interference of patient family members as potential causes of pediatric safety events. In addition, while surveyed EMS providers identified medication errors and team member communication among patient safety causes, these factors ranked much lower than what was seen in in-hospital settings, illustrating a viable difference between in-hospital and out-of-hospital care scenarios.

"EMS is an essential contributor to health and health care delivery,” said Beech Stephen Burns, M.D., head of pediatric emergency medicine at OHSU Doernbecher Children's Hospital, OHSU School of Medicine. "When considering that there are an estimated 800,000 to 1.6 million EMS transports of children each year in the U.S., the value of enhancing pediatric training becomes even more apparent to ensure the best outcome for our patients and their families.”

This research is a part of a multiphase study funded by the National Institute of Child Health and Human Development, National Institutes of Health (NICHD R01HD062478).

About OHSU

Oregon Health & Science University is a nationally prominent research university and Oregon's only public academic health center. It serves patients throughout the region with a Level 1 trauma center and nationally recognized Doernbecher Children's Hospital. OHSU operates dental, medical, nursing and pharmacy schools that rank high both in research funding and in meeting the university's social mission. OHSU's Knight Cancer Institute helped pioneer personalized medicine through a discovery that identified how to shut down cells that enable cancer to grow without harming healthy ones. OHSU Brain Institute scientists are nationally recognized for discoveries that have led to a better understanding of Alzheimer's disease and new treatments for Parkinson's disease, multiple sclerosis and stroke. OHSU's Casey Eye Institute is a global leader in ophthalmic imaging, and in clinical trials related to eye disease.

About OHSU Doernbecher Children's Hospital 

OHSU Doernbecher Children's Hospital ranks among the nation's Best Children's Hospitals,* is one of 21 members of the Children's Oncology Group's Phase 1 and Pilot Consortium, and ranks 39th for NIH awards to children's hospitals and their university-affiliated Department of Pediatrics.** Nationally recognized physicians and nurses provide a full range of specialty and subspecialty care to tens of thousands of children annually, resulting in 200,000 discharges, surgeries, transports and outpatient visits annually in a patient- and family-centered environment. OHSU Doernbecher providers also travel throughout Oregon and Southwest Washington, providing specialty care to more than 3,000 children at more than 200 outreach clinics in 15 locations. Using state-of-the-art, secure two-way video and audio communication, OHSU Doernbecher's Telemedicine Network connects pediatric intensivists and neonatologists to emergency room physicians statewide to help evaluate time-critical pediatric patient needs and assist with treatment plans.

* U.S. News & World Report 2015-16 Best Children's Hospitals
** Children's Hospital Association