Transcript APDC - PPEC presentation - Arizona Pediatric Disaster Coalition

A PARTNERSHIP BETWEEN THE ARIZONA DEPARTMENT OF HEALTH
SERVICES, THE ARIZONA CHAPTER – AAP, AND ARIZONA HOSPITALS
2007 Report 6% of EDs in the US
have all of the
supplies deemed
essential for
managing pediatric
emergencies
Only half of hospitals
have at least 85% of
those supplies
Pediatric treatment
patterns vary widely
among emergency
care providers
Many providers
undertreat children,
many fail to recognize
cases of child abuse
EMS for Children – call to arms
Pediatric Prepared Emergency Care
April 2008
Stakeholder Meeting – Hospital CEOs, Emergency Department
Leadership
2008 – 2010
Stakeholder Committee Meetings – review and refine criteria
Late 2010
Program transferred to AzAAP, Formal Steering Committee seated
December 2011
Initial site visits
March 2012
7 Advanced Care sites, 2 Prepared Plus sites certified by AzAAP Board
November 2014
31 Hospital Members
21 Hospital EDs certified , 2 pending approval
AZ Goal – Inclusive Regionalized System
of Care
Voluntary System Developed by ED Nurses and Physicians
Oversight is by the American Academy of Pediatrics AZ Chapter
Three tiers –
◦ Advanced Care
◦ Prepared Plus Care
◦ Prepared Care
Sustainability: Membership and Certification Fees
Consultation and Education
Levels of Care – Names not Numbers
Certification is available for three levels of care- the hospital decides what level to apply for:
Prepared Care - This level of certification provides services for pediatric care as part of a general
Emergency Department. The hospital refers critically ill or injured children to other facilities and
may or may not have pediatric inpatient services available. M $1500/C$1000
Prepared Plus Care - This level of certification provides services for most pediatric emergency
care. The hospital may have a focus on pediatrics, but ICU services for children are not
available. M$2000/C$1500
Prepared Advanced Care -This level of certification provides services for all levels of pediatric
emergency care. This hospital system includes a Pediatric intensive care unit and has a specific
focus on pediatric services. M $2500/C$2000
WIIFM?
•Members discussion forum
• members share guidelines, procedures, issues and questions
•Free educational classes and trainings
• Certified Emergency Nurse Review Courses
• Emergency Nursing Pediatric Courses
• COMING SOON – Advanced Pediatric Life Support, Newborn Resuscitation Program
and/or STABLE
•Identification and action on issues common to most or all EDs
•Site visit participants share learning
Regionalization work in other states
State Partnership for Regionalization of Care (SPROC)
◦ To get the right resources to the right patient at the right time
◦ AK - increasing pediatric focus in a variety of programs, including disaster preparedness, trauma, gen training, and regionalized
care
◦ AZ – Expand PPEC into rural and tribal communities, integrate evidence-based guidelines into clinical decision-making
◦ CA - North Coast EMS, UC Davis, IHS, focus on evidence-based emergency medical services, including transport or telemedicine;
education
◦ MT – implement the Montana Inclusive Model of Pediatric Emergent Care, focusing on acutely ill and severely injured children
◦ NM – interface between community focus – community readiness, EMS, and helping facilities to get them ready to manage
pediatric emergencies
◦ PA – Focusing on western PA and building collaboration/relationships between academic center and rural community health
providers.
State Regionalization Systems
◦ Illinois, Tennessee, CA (regions), Maryland, Oklahoma
Measurement/Systems
Why Pediatric
Readiness?
Pediatric ED Visits
• Children constitute 1/4 of all ED visits
– Most children seek care in local community
ED
– Children usually arrive in personal vehicle
• 82.7% of Nation’s EDs want to become
Pediatric Ready
National Pediatric Readiness Project
• Multi-phase quality improvement initiative
• Based on Joint Policy Statement: Guidelines for the Care of
Children in the Emergency Department
• Self-assessment with immediate feedback
• Benchmarking in groups by pediatric volume
• Access to QI resources targeted to identified need
Purpose
• Establish a baseline of nation’s capacity to provide pediatric
emergency care in the ED
• Create a foundation for QI process
– Includes implementation of Joint Policy Statement
• Develop benchmarks to measure improvement over time
Collaboration
•
•
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•
•
•
Federal EMS for Children Program (HRSA-MCHB)
American Academy of Pediatrics (AAP)
American Academy of Emergency Physicians (ACEP)
Emergency Nurses Association (ENA)
EMS for Children National Resource Center (NRC)
National EMS for Children Data Analysis Resource Center
(NEDARC)
The Assessment
Goal
• To assess every emergency department (ED) in
the nation
• Over 5000 facilities identified by
– The 2009 American Hospital Association
Healthcare Dataview
– EMS for Children State Partnership grantees
Instrument
The National Pediatric Readiness Assessment
includes questions that address the following areas
of the Joint Policy Statement:
– Administration and Coordination
– Physician, Nurses, and Other ED Staff
– QI/PI in the ED
– Pediatric Patient Safety
– Policies, Procedures, and Protocols
– Equipment, Supplies and Medications
Feedback
• Respondents received immediate feedback:
– Readiness Score
• based on 6 areas of Joint Policy Statement
• Weighted scores on scale of 0-100
• Compared with similar pediatric volumes and all facilities
– Gap analysis report
• Individualized summary of strengths and weakness
• Directed respondent to targeted components in the Pediatric Readiness
Toolkit
• Suggested starting point; not all inclusive
National Results
The National Picture
% EDs by Volume
< 5 children/day
14%
39%
17%
5- 14 children/day
15-25 children/day
>25 children
30%
N=4,143
(82.7% of all EDs)
Quality and Process Improvement helps to ensure:
• Processes are in place to review clinical cases
• Data is gathered to measure deviation from best practices or errors
in care
• Use of appropriate metrics to evaluate and improve health
outcomes of children
• Integration with other QI committees for the coordination of care
throughout the medical continuum
Guidelines for Improving Pediatric Patient Safety in the
ED help to ensures:
• Polices and practices are in place to address unique pediatric
patient safety concerns
Note: The delivery of pediatric care reflects an awareness of the unique
needs to improve health outcomes of children.
Guidelines for Equipment, Supplies, and Medication for the
care of Pediatric Patients helps ensure:
• Availability and accessible for all ages and sizes
• Equipment, supplies, and medication are logically and safely
organized
• Staff are educated on location and function of all equipment and
supplies
• Daily verification/check list process is in place for all equipment and
supplies
Members
Arizona Children's Center at Maricopa Medical Center
Banner Baywood Medical Center
Banner Boswell Medical Center
Banner Del E. Webb Medical Center
Banner Estrella Medical Center
Banner Gateway Medical Center
Banner Ironwood Medical Center
Banner Page Hospital
Banner Thunderbird Medical Center
Benson Hospital
Cardon’s Children’s Medical Center
Cobre Valley Regional Medical Center
Chinle Comprehensive Health Care Facility
Copper Queen Community Hospital
Gila River Hu Hu Kam Memorial Hospital
John C. Lincoln Deer Valley Hospital- Mendy's Place
Northern Cochise Community Hospital
Oro Valley Hospital
Parker Indian Health Center
Phoenix Baptist Hospital
Phoenix Children’s Hospital
Scottsdale Healthcare- Osborn Medical Center
Scottsdale Healthcare- Shea Medical Center
Scottsdale Healthcare- Thompson Peak Medical
Center
Summit Healthcare Regional Medical Center
Tuba City Regional Health Care
Tucson Medical Center for Children
University of Arizona Medical Center- Diamond
Children’s Medical Center
Verde Valley Medical Center
White Mountain Regional Medical Center
Yuma Regional Medical Center
Shared Learning
Relationships then Partnerships Lead to
Practice Change
Criteria changes occur every 3 years
Based on new evidence and is
concensus
Wins –
◦ Weights in kilograms
◦ Improved child abuse policies
◦ Mock codes
◦ Disaster preparedness
◦ Equipment in place
◦ Clinical pathways shared
◦ Improved flow
Next Steps –
◦ Full set of vital signs on all kids
◦ % nurses with CEN, CPEN
◦ Identify joint QI targets
Steering Committee
Kim Choppi, RN
Kathy Northrop, RN
Alan Frechette, MD
James Reingold, MD
Toni Gross, MD
Teresa Salama
Anthony Huma
Peggy Stemmler, MD
Kathy Karlberg, RN
Tomi St. Mars, RN
Pamela Murphy, MD
Susan Thomas, RN
Craig Norquist, MD
Dale Woolridge, MD
Improvement is a Journey
“Do not judge me by my
successes. Judge me by how
many times I fell down and got
back up again.”
— Nelson Mandela 1918-2013