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Delivering Value Through Evidence-Based Practice
Unwanted variation in care is a challenge to high-quality care delivery in any healthcare system. Across the Emergency Medical Services for Children (EMSC) continuum, there is wide variation in care delivery for which best practices have demonstrated opportunities to minimize that variation through clinical standards (evidence-based pathways, protocols, and guidelines for care). A model of development of clinical standards is delineated and tools used in that process are described. Implementation strategies for improving utilization are also described with clinical decision support tools being a promising strategy for acce...
Source: Clinical Pediatric Emergency Medicine - June 1, 2017 Category: Emergency Medicine Authors: Charles G. Macias, Jennifer N. Loveless, Andrea N. Jackson, Srinivasan Suresh Source Type: research

Pediatric Quality Improvement Engagement In The Community Setting
Providing safe, high quality care to pediatric patients is a core goal for all healthcare systems. To this end, robust quality improvement and patient safety methodologies have been developed to improve pediatric patient care in academic medical centers. However, given that the majority of pediatric patients are first seen in emergency departments (EDs) in community hospitals rather than academic pediatric medical centers, there is an urgent need to adapt these methodologies to the community ED environment. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - June 1, 2017 Category: Emergency Medicine Authors: Alla Smith, Melissa Sundberg Source Type: research

Value and Improvement Science in Pediatric Emergency Care
The health care landscape is changing dramatically with United States health care expenditures continuing to rise to unprecedented levels. A variety of strategies over the past few decades have been theorized or implemented to bend the cost curve but no strategy has yet had long-term sustained results. Recently, Professor Michael Porter, a business strategy expert and his colleagues from Harvard Business School shifted their focus to health care and conceptualized a fundamentally novel strategy centered around value. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - June 1, 2017 Category: Emergency Medicine Authors: George R. Verghese, Raina M. Paul Tags: Guest Editors Preface Source Type: research

Table of Contents
(Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - June 1, 2017 Category: Emergency Medicine Source Type: research

Editorial Board
(Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - June 1, 2017 Category: Emergency Medicine Source Type: research

The Little Program That Could: Saving Emergency Medical Services for Children
The experience of the federal Emergency Medical Services for Children program over the past 30 years illustrates many of the challenges facing those who advocate for programs that serve special populations or targeted purposes. Even programs that are well run and successful may find themselves targeted for budget cuts or elimination if they do not have committed champions, a readily identifiable constituency, and a range of resources at their disposal. The long campaign to preserve the Emergency Medical Services for Children program has yielded valuable lessons for advocates working at any level of government. (Source: Cli...
Source: Clinical Pediatric Emergency Medicine - June 1, 2017 Category: Emergency Medicine Authors: Cynthia Pellegrini, Steven E. Krug, Joseph L. Wright Source Type: research

Using the PRISM Model to Drive Quality Improvement in the Emergency Department
In recent years, there has been a push to improve and standardize the quality of clinical care delivered. This has led to marked efforts across institutions to invest in quality improvement (QI) as a part of daily practice. “Problem-solving, Root cause analysis, Improvement Science, and Maintenance/Monitoring” (PRISM) is a model used to detail a stepwise approach to QI in a way that can be easily followed, sustained, and eventually integrated into an organization’s learning system. This model is being used to imp rove the efficiency of our emergency department admissions process. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - May 26, 2017 Category: Emergency Medicine Authors: Ami Mehta, Lindsay F. Eilers, Adam M. Campbell, Dana W.E. Ramirez, Sandip A. Godambe Source Type: research

One Hospital's Experience With an Annual Surge of Intoxicated Teens
Lollapalooza is an annual music festival that brings hundreds of thousands of concert-goers to Chicago, many of whom are adolescents. Emergency departments (EDs) see a surge of adolescent patients during seasonal events such as this, which places a strain on resources and provides unique challenges. The variation in care that Lollapalooza patients receive has served as a source of data for quality improvement initiatives within our ED. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - May 24, 2017 Category: Emergency Medicine Authors: Emily C.Z. Roben, I. Allie Hurst, Mark Adler Source Type: research

Lollapallooza: A Predictable “Disaster”
Lollapalooza is an annual music festival that brings hundreds of thousands of concert-goers to Chicago, many of whom are adolescents. Emergency departments (EDs) see a surge of adolescent patients during seasonal events such as this, which places a strain on resources and provides unique challenges. The variation in care that Lollapalooza patients receive has served as a source of data for quality improvement initiatives within our ED. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - May 24, 2017 Category: Emergency Medicine Authors: Emily C.Z. Roben, I. Allie Hurst, Mark Adler Source Type: research

Development of a Longitudinal Quality and Safety Curriculum for Pediatric Emergency Medicine Fellows
In this article, we describe the development and assessment of a 2-year longitudinal quality improvement (QI) and patient safety curriculum that matches didactic education with experiential learning in a pediatric emergency medicine fellowship. The curriculum includes the development of a comprehensive didactic series and an improvement project identified, designed, and implemented by the fellows. The curriculum was assessed through a questionnaire administered before and after participation in the curriculum, along with an evaluation of the clinical impact of the completed project and assessment of a scholarly product. (S...
Source: Clinical Pediatric Emergency Medicine - May 19, 2017 Category: Emergency Medicine Authors: Matthew A. Eisenberg, Joshua Nagler, James Moses, Raina Paul, Joel Hudgins Source Type: research

Development, Implementation, and Use of an Emergency Physician Performance Dashboard
Proficient physician performance is crucial to high-quality health care. Physicians must acquire and apply new knowledge and skills throughout their careers. Successful physician performance improvement requires leadership with vision and a strategic plan, engagement of front line providers, resources and support to improve, and feedback and communication that facilitates a culture of learning and improvement. A fluid and balanced performance dashboard, aligned with local improvement efforts, can inform individuals and groups of physicians, ensure the trust of other stakeholders, and improve the quality of patient care. (S...
Source: Clinical Pediatric Emergency Medicine - May 16, 2017 Category: Emergency Medicine Authors: Catherine E. Perron, Richard G. Bachur, Anne M. Stack Source Type: research

The State of Quality Improvement Training in Pediatric Emergency Medicine Programs: A National Survey of Fellowship Program Directors
The Accreditation Council for Graduate Medical Education requires training in quality improvement (QI) but does not provide specifics of content or methods. We aimed to describe the current state of pediatric emergency medicine (PEM) fellowship training in QI and the integration of such QI training with related institutional efforts. We surveyed PEM fellowship program directors (PDs) between January 2017 and March 2017. A group of PEM-boarded physicians with expertise in QI created survey questions to assure face validity. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - May 11, 2017 Category: Emergency Medicine Authors: Margaret S Wolff, Wendi Jo Wendt, Paul Mullan, Prashant Mahajan, Raina Paul Source Type: research

Information Engineering for Value in Pediatric Emergency Medicine
Emergency medicine continues to suffer from information gaps that limit progress on measurement and action on quality of care. Important progress has been made in defining structure, process, and short-term outcome measures that occur within the time boundary of the emergency department (ED) visit itself for ill and injured children. However, true progress toward value-based care requires insight into outcomes beyond the walls of the ED. Existing measures such as return visits are not uniformly endorsed as a reliable and actionable measure of quality. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - May 8, 2017 Category: Emergency Medicine Authors: Stephen C Porter Source Type: research

An Update on Common Orthopedic Injuries and Fractures in Children: Is Cast Immobilization Always Necessary?
Children frequently visit emergency departments for injuries and fractures related to sports and recreational activities; however, the routine care of these acute minor injuries is shifting to the domain of urgent care centers. Physicians on the front lines may not have access to real-time orthopedic consultation and therefore need to be versed in the diagnosis and treatment of common pediatric fracture patterns recognizing potentially operative fractures as well as injuries that may not even require follow-up care. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - March 1, 2017 Category: Emergency Medicine Authors: Brian Tho Hang, Claire Gross, Hansel Otero, Ryan Katz Source Type: research

Urgent Care as Intermediary Care: How Inbound and Outbound Transport Can Enhance Care of Community-Based Pediatric Emergencies
With increasing options for acute care outside the medical home, high-functioning freestanding pediatric urgent care centers (UCCs) have become epicenters for intermediary care: alternate destinations for acutely ill or injured children with serious but not imminent life-threatening problems. Pediatric UCCs may be an optimal site to treat low acuity emergency medical services (EMS) patients, to triage true pediatric emergencies, and to develop universal transfer protocols to transition children to hospitals for higher levels of acute or subspecialty care. (Source: Clinical Pediatric Emergency Medicine)
Source: Clinical Pediatric Emergency Medicine - March 1, 2017 Category: Emergency Medicine Authors: Caleb Ward, Therese L. Canares Source Type: research