Community emergency departments see the majority of children receiving emergency care. However, each of these emergency departments may only see a small volume of pediatric patients per day, often leaving staff uncomfortable when caring for sick infants. By forming partnerships between an academic pediatric emergency department and community emergency departments, we sought to improve the clinical skills of community staff caring for infants with bronchiolitis, a common pediatric presentation. We created a training module that summarizes evidence-based best practices for bronchiolitis management and conducted hands-on suctioning simulations with 31 community emergency department nurses and respiratory therapists. Through education and simulation on bronchiolitis care, the majority of study participants were confident in their ability to improve their care of children with bronchiolitis and intended to change their practice. This multi-center pilot study highlights the power of academic and community emergency department partnerships in enhancing continuing education and promoting pediatric care quality in community emergency departments.
Evaluating and improving the quality of care requires efficient and accurate data collection. This study aimed to evaluate the feasibility and compliance of quality indicators (QIs) for pediatric patients with asthma, bronchiolitis, and croup in emergency departments (EDs), to compare QI measurement using prospective direct observation and chart audit, and to explore factors influencing QI feasibility and compliance. A mixed-methods study was conducted in two EDs between September and October 2024. The feasibility and compliance of 26 QIs were assessed through prospective observation of ED care for asthma (n = 249), bronchiolitis (n = 91), and croup (n = 147), alongside retrospective chart audits. Semi-structured interviews with nine pediatric residents were conducted to explore factors influencing QI feasibility and compliance. All 26 QIs were feasible during prospective observation, whereas only 16 (61.5%) were feasible using chart audits. Compliance varied across indicators, with consistently higher estimates observed using prospective observation and marked discrepancies for several clinical assessment and treatment indicators. Overuse of radiography and antibiotics was identified across all three conditions. Thematic analysis identified eight themes and 17 subthemes related to documentation practices, workload, and system-level challenges. QIs based on electronically recorded clinician orders were consistently captured using both methods, whereas those relying on physical assessment and clinical documentation were not reliably captured in chart audits. Compliance was generally acceptable but lower for clinical evaluation and diagnostic indicators, highlighting the need for complementary data collection methods.
This review synthesizes best practices for ambulatory pediatric tonsillectomy with or without adenoidectomy in ambulatory surgery centers. It emphasizes rigorous patient selection-particularly for severe obstructive sleep apnea, age, obesity, and complex comorbidities-along with individualized anesthetic plans (induction and airway choice), multimodal opioid-sparing analgesia, and robust post-operative nausea and vomiting prophylaxis. Standardized post-anesthesia care unit monitoring, discharge criteria, caregiver education, and escalation pathways address common complications (airway events, hemorrhage, pain, dehydration). Preparedness-pediatric advanced life support-certified staff, emergency equipment, and transfer agreements-underpins safety. Quality-improvement initiatives and emerging tools offer avenues to further reduce morbidity and unplanned admissions.
Palliative care has been recognized as an essential component of a humanitarian response; however, it remains unavailable in most humanitarian crisis settings. Globally, healthcare workforce capacity represents a major barrier to implementing children's palliative care, and there is limited evidence to guide educators on the learning needs and preferences of healthcare professionals working in humanitarian settings. The primary objective of this study was to explore the extent of training, experience, and confidence in children's palliative care among healthcare professionals working in humanitarian settings. Secondary objectives were to identify perceived educational needs, including priority learning topics and preferred methods of palliative care education. We conducted a cross-sectional survey of healthcare professionals with experience working in humanitarian settings. The survey assessed participants' self-reported knowledge, confidence, attitudes, prior training experiences, and learning preferences related to children's palliative care. One hundred thirty four healthcare professionals participated, including nurses (37%), physicians (17%), and clinical officers (15%). Most participants provided clinical care (n = 82, 64%) and were locally recruited staff (83%). More than 70% of respondents reported having some palliative care training, either during their professional training (n = 52) or through continuing medical education (n = 41). Despite this, many participants reported discomfort with key palliative care situations, including forming a therapeutic relationship with families of dying children (61%) and discussing impending death with parents (61%). Nearly all respondents (98%) expressed interest in further training, with preferred learning modalities including online teaching sessions and web-based certificate courses. There is strong interest and awareness for children's palliative care training amongst humanitarian healthcare professionals. Despite prior exposure to palliative care education, many participants report limited confidence and skill in providing children's palliative care, particularly in communication and psychosocial domains. Health educators should consider developing online training programs on children's palliative care to meet the educational needs of healthcare professionals in humanitarian settings.
Communication in a family's primary language can support safe care. Vital steps within the care delivery process are contingent on successful communication, including reporting symptoms, clinical decision-making, informed consent, discharge communication and follow-up coordination. The importance of effective information exchange is particularly pronounced in paediatric emergency care, and complex interactions may arise as parents or carers advocate on behalf of children. This scoping review aimed to identify and map existing research indicating where along the care journey communication-related risks for safety lie during paediatric emergency care and what strategies exist to mitigate them. We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science and Cochrane Library for studies which examined the influence of language barriers on patient safety in paediatric emergency care as well as studies that evaluated interventions. Bibliographic database searches were executed on 18 December 2024; retrieved records were independently screened by two authors at title and abstract level followed by full text level. Data on study objectives, population characteristics, study design and their key findings were extracted. 1578 articles were identified, of which 33 were included and mapped according to (i) studies reporting safety risks linked to language barriers in paediatric emergency care (n=24) and (ii) existing interventions designed to mitigate these risks (n=9). Studies highlighted that language barriers can influence safety at multiple stages of the emergency care pathway, with discharge most frequently reported as a point of risk for paediatric patient safety. Interventions focused primarily on usage, uptake and documentation of professional interpreter services. Addressing misunderstandings around follow-up and home-care advice during medical safety netting are priority areas for intervention. Future research should involve carer and clinical perspectives in exploring whether technology-enabled tools, including artificial intelligence, can safely mitigate language barriers in these situations.
Pediatric emergency nursing requires timely, accurate interventions, yet educational content is not always aligned with clinical priorities. Identifying and prioritizing educational gaps based on clinical relevance and nurses' current performance is essential to improve pediatric emergency care. This descriptive cross-sectional study assessed clinical performance and educational needs among nurses working in emergency departments, general wards, and intensive care units. Data were collected using a structured questionnaire on 20 pediatric emergency conditions and related procedures. Priorities were identified using the Borich Needs Assessment and the Locus for Focus model, based on differences between required and present competence and the level of perceived importance. Educational needs were consistently high across participant characteristics. In both the Borich needs assessment and the Locus for Focus model, the highest priorities were identified in pediatric emergency nursing competencies related to time-critical emergencies and core procedures, particularly resuscitation and high-risk medication administration. Educational priorities in pediatric emergency nursing span urgent conditions and skill-intensive procedures. Although performance varied by age and experience, educational needs were consistently high, supporting continuous, standardized training. Simulation-based and mobile-enabled, scenario-focused education should be considered to enhance preparedness and response capacity among nursing students and early-career nurses.
Physician workload in pediatric emergency departments (PEDs) is associated with patient safety, quality of care, and clinician well-being, but is commonly inferred from proxy measures such as visit volume, acuity, or throughput metrics that incompletely capture the contextual and cognitive demands of clinical care. The Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED) was developed to quantify workload at the level of discrete clinical tasks. We derived workload estimates and evaluated the reliability, precision, and contextual responsiveness of SWAMPED. We conducted a multicenter cross-sectional study of PED physicians at tertiary children's hospitals within the Pediatric Emergency Research Canada network. Participants independently scored 46 care components using the NASA Task Load Index, a validated multidimensional instrument that measures perceived workload associated with a specific task (in this case a clinical care component) accounting for six domains of effort (mental, physical, time, effort, performance, and frustration). Six extrinsic patient and systems-level modifiers were assessed for their impact on component-level workload. We assessed score distributions, interrater agreement using intraclass correlation coefficients (ICC), precision of component estimates, and extrinsic modifiers' effects using mixed-effects models. Sixty-two physicians from 11 sites participated. Interrater agreement across care components was good (ICC: 0.69, 95% CI: 0.60-0.78). Mean workload scores varied across care components (range 22.1-99.5) with high precision (95% CI margin of error of 2.5-6.5 points; relative margin 5%-10%). Most components demonstrated increased workload in the presence of extrinsic modifiers, while intrinsic physician characteristics were not associated with significant differences in workload scores. SWAMPED generated reliable and precise, task-specific workload estimates and demonstrated sensitivity to clinically relevant contextual modifiers. This approach enables quantitative assessment of physician workload at the task level and provides a foundation for future investigations linking workload to clinical outcomes, clinician performance, and health system planning.
Management of the pediatric airway is a challenging procedure in prehospital emergency medicine. This retrospective study evaluates prehospital airway management in 920 pediatric patients in a German helicopter emergency medical service (HEMS) system from 2012 to 2021. Prehospital pediatric intubation was a rare event (0.2% of all missions). Good visualization of the glottis (Cormack-Lehane I or II) was possible in 96.3% of the intubations. The first-pass intubation success was 86.6%; all children could finally be intubated successfully. The use of muscle relaxants significantly improved first-pass success in prehospital emergency anesthesia (90.1% vs. 83.1%; P = .002). We recognized a low rate of the use of aids such as stylet, bougie, or video laryngoscopy. The use of video laryngoscopy increased over the years, but did not translate into a higher first-attempt success rate. When taking over children with an already managed airway, HEMS teams found tube malplacement in 8.4% of the cases in primary missions. In the analyzed data, pediatric airway management was on a comparable level with adult airway management. Nevertheless, room for improvement and a need for further studies were identified.
Emergency department presents a distinctive challenge for implementation infection prevention and control (IPC), due to their complex and dynamic environment, diverse patient population, and unknown carrier status. The objective was to assess the compliance with a number of IPC practices among a group of healthcare workers (HCWs) working in the emergency department. An observational cross-sectional study was conducted at a large emergency department at a tertiary care hospital between 2018 and 2023. Data were gathered during observation sessions using a standardized IPC observation form. Observers were either experienced IPC professionals or trained medical students. Out of 123,947 HCW-specific practices observed, 85,542 (69.0%) were compliant and out of 41,650 unit-specific practices observed, 38,355 (92.1%) were compliant. The compliance was highest in the competence of acute respiratory infection procedures (97.3%), followed by isolation precautions (97.0%), housekeeping (96.8%), disposal of sharps (96.8%), waste management (94.5%), donning and doffing of personal protective equipment (PPE, 72.9%), use of PPE (72.3%), hand hygiene (67.2%), patient sitters (64.1%), and disinfection of medical equipment (61.2%). Nurses across all units had much better compliance than other professions. There were > 10% differences in the compliance across the units, with higher compliance in mainly pediatric compared with adult units. The compliance was highest during the COVID-19 pandemic years. There is considerable variability in implementation of IPC at the emergency department, by practice, profession, unit, and pandemic time. The findings underscore the importance of strategies to improve disinfection of medical equipment, hand hygiene, and adherence of patient sitters.
Across the United States, access to pediatric inpatient units, specialists, and intensive care units is becoming more concentrated in tertiary children's hospitals. Although this shift enables consolidation of resources and expertise, it also results in a significant access gap for millions of children living in rural communities nationwide. Children in regions lacking local pediatric services face disparities in identification of critical illness, delays in transport to definitive care, and an increased risk of adverse outcomes. These discrepancies raise an important question: How can the pediatric community ensure that every child receives excellent care, regardless of their location?
Injury to the pediatric hand is common, yet acute management techniques are variable due to limited evidence-based guidance. The initial evaluation and treatment often falls to emergency department physicians, on-call orthopaedic surgeons, or primary care providers, who may lack specialized training or experience in pediatric hand injuries. The purpose of this three-part series is to provide education about the differences in management of pediatric hand patients, as compared to adult hand care. Additionally, it provides recommendations for the initial management of traumatic hand injuries in skeletally immature patients, guided by the literature where possible. This includes the management of urgent and emergent traumatic pathologies, including digital amputations and joint dislocations, in addition to common pediatric pathology. (1)Pediatric-specific anatomy and physiology require different management strategies for hand injuries compared to adults.(2)Not all pediatric hand injuries will be okay without active management; early detection and referral can be crucial.(3)System-wide coordination among primary care, the emergency department, on-call orthopaedic surgeons, and hand specialists is essential for optimal management of pediatric hand trauma.
Children with skin color (SOC) are underrepresented in dermatologic research, despite structural and functional differences that shape disease presentation. Atopic dermatitis (AD), one of the most common pediatric dermatoses, often appears differently in SOC than in white children. This study compared dermatologic conditions prompting Pediatric Emergency Department (PED) referral in SOC and white children, and described clinical features of AD in SOC. A retrospective study was performed at IRCCS AOUBO Policlinico di Sant'Orsola, Bologna, Italy, analyzing records and photographs from 2019. Patients presenting with dermatologic conditions and evaluated by a pediatric dermatologist were included. Of 411 patients, 109 (26.5%) had SOC. In SOC, common diagnoses were scabies (22%), AD (17.4%), viral infections (12.8%), burns (9.2%), and contact dermatitis (7.3%). In white children, viral infections (16.9%), burns (14.2%), contact dermatitis (13.9%), AD (12.9%), and insect bites (5.6%) predominated. Scabies and pruritus were significantly more frequent in SOC (p < 0.05). Among 38 SOC patients with AD, lichenoid (31.6%), pityriasis alba (29.0%), prurigo nodularis (26.3%), and classic AD (13.2%) were the most frequent variants. Erythema was often subtle or absent. Dermatologic conditions and AD morphology differ between SOC and white children, highlighting the need for tailored diagnostic approaches and equitable care.
Survival rates for childhood cancer remain far lower in low- and middle-income countries (LMICs) compared to high-income countries (HICs). In Tanzania, challenges in cancer care for children are driven by shortages of trained providers, limited infrastructure, and constrained access to essential medications. This study evaluates pediatric oncology capacity and infrastructure in Northern Tanzania to identify system gaps and opportunities for improvement. A cross-sectional survey of capacity for pediatric cancer care was conducted at 25 hospitals across the Kilimanjaro, Arusha, Manyara, and Tanga regions in Tanzania. Facilities included health centers, district hospitals, regional hospitals, and one zonal referral hospital. Using a tool adapted from the International Society of Paediatric Oncology (SIOP) Global Mapping Survey, the World Health Organization Essential Medicines List, and the Global Initiative for Childhood Cancer, we collected data on hospital infrastructure from hospital leaders and staff. Key indicators included diagnostic imaging, pathology services, oncology workforce, medicine availability, treatment modalities, and cancer case volumes. Descriptive statistics were summarized using R. Of the facilities surveyed, only one hospital (Kilimanjaro Christian Medical Centre) had a dedicated pediatric oncology ward and subspecialized staff. Although all facilities reported access to basic imaging such as x-ray and ultrasound, advanced imaging modalities (CT, MRI, specialized imaging) were confined to higher-level hospitals. Only 1 out of 25 hospitals offered pathology and pediatric surgical services. Among 20 essential pediatric oncology medicines assessed, only dexamethasone was universally available. District hospitals, despite serving the largest pediatric catchment areas and recording the highest admissions for children, lacked dedicated pediatric oncology wards. Pediatric oncology services in Northern Tanzania are constrained by shortages in infrastructure, personnel, diagnostics, and medications. District hospitals have limited capacity to treat childhood cancer, resulting in critical delays in diagnosis and treatment. Strengthening infrastructure at the district level, creating efficient referral systems, and embedding pediatric oncology care into broader health systems may improve survival outcomes for children with cancer.
Standardized post-graduate education in pediatric transfusion medicine remains limited. The objective of this study was to adapt an adult transfusion education program, Transfusion Camp, to include pediatric content and assess knowledge improvement in pediatric subspecialty trainees. A steering committee of Canadian experts from pediatric subspecialties convened to adapt the content of an adult transfusion medicine curriculum to include pediatric-specific content using Kern's six-step approach to curriculum design. Pediatric anesthesiology and pediatric hematology-oncology trainees enrolled in Canadian training programs participated in a 4-day pilot of virtual didactic teaching/team-based learning during the 2024-2025 academic year. Knowledge was assessed using the validated 25-item Pediatric Transfusion Knowledge Test administered pre- and post-course. Trainees also completed surveys evaluating confidence and attitudes. Twenty-eight trainees enrolled in the course, 26 trainees completed the pre-course assessment, and 21 completed the post-course assessment. Of these, 20 completed both pre- and post-course assessments, and 80% (16/20) attended all 4 days. Mean scores increased from 48.9% ± 13.3% to 64.6% ± 12.1%. Among trainees completing both pre- and post-course assessment (n = 20), the mean gain was +17.8% (95% confidence interval 11.2-24.4, p < .0001). Knowledge gaps persisted in transfusion reaction reporting and specialized transfusion topics, including platelet refractoriness and hemolytic anemia. Trainees reported improved confidence in applying transfusion medicine concepts, and course evaluations were highly positive. Pediatric Transfusion Camp is a standardized, evidence-based curriculum that improves pediatric trainee transfusion knowledge. Engaging a multi-disciplinary steering committee enhanced educational rigor and supports future expansion toward standardized pediatric transfusion medicine training across Canada.
Transfers of children with minor injuries, rather than complex trauma requiring specialized care, create unnecessary strain on patients, families, and healthcare resources. While existing research has examined transfers for specific injury categories, our study comprehensively investigates the factors driving potentially avoidable transfers (PATs) among pediatric patients with diverse facial fracture presentations, as well as the economic impact associated with these transfers. A retrospective analysis examined facial fractures in pediatric patients at our level I pediatric trauma center from 2006 to 2021. We defined Potentially Avoidable Transfers (PATs) as cases with hospital stays under 24 h, no admission, no surgery, and no emergency or specialized procedures post-transfer. We analyzed demographics, medical history, injury characteristics, associated injuries, treatments, and outcomes using logistic regression, chi-square, or Fisher's exact tests in Stata SE Software (Version 17.0, College Station, TX). Of 3334 pediatric patients identified, 3132 patients met inclusion criteria; of these, 1251 (40.1%) were transferred from a community hospital and 297 (23.7%) met our definition of a PAT. Potentially avoidable transfers were predominantly male (n = 217, 73.1%) and 11 years of age on average. Key patient characteristics associated with PAT were lack of medical insurance (p = 0.004, OR = 1.83), age less than six years age (p = 0.007, OR = 1.98), and the presence of an orbital or mandible fracture (p = 0.001, OR = 1.83). A single PAT incurred a cost of $2125.90 at the receiving hospital, with most expenses resulting from imaging and laboratory tests. PATs impose substantial logistical and economic challenges for patients and healthcare systems. We propose developing transfer protocols to enhance clinical decision-making, potentially reducing unnecessary transfers while ensuring patient safety. Remote specialist consultation for pediatric patients could also optimize care by minimizing unwarranted transfers.
Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population. To identify the rates and types of patient safety events within a US national pediatric population receiving HHC. This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC. Days of HHC receipt. Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index. This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology. In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.
Drug-induced acute dystonia is an adverse drug reaction that is concerning in pediatric patients but resolves rapidly with appropriate treatment. In children, data on risky drugs, clinical patterns, and the management of dystonia in the emergency department are limited. This study aimed to evaluate the demographic and clinical findings and treatment outcomes of children presenting to the pediatric emergency department with drug-induced acute dystonia. This retrospective observational study includes children aged 1 month to 18 years who were diagnosed with acute dystonia in a tertiary pediatric emergency department between October 2022 and March 2025. The diagnosis was made by a pediatric emergency subspecialist based on clinical findings. Patients were classified according to clinical phenotype as focal/segmental dystonia (group I) and multifocal/generalized dystonia (group II). Demographic data, drug exposures, clinical characteristics, and treatment responses were analyzed. A total of 79 patients were included in the study. The median age was 11 years (IQR: 7 to 16) in group I and 10 years (IQR: 6 to 16) in group II. The most commonly associated drug groups were antipsychotics (55.6%), antiemetics (26.6%), and psychostimulants (20.3%). Focal dystonia is the most common clinical pattern, affecting the head and neck muscles in 61% of cases. The use of metoclopramide was significantly higher in group I (OR: 0.21; 95% CI: 0.04-0.99). All patients were treated with parenteral biperiden. Antipsychotics and antiemetics are the main triggers of drug-induced acute dystonia in children. Dystonia usually appears within the first 72 hours after starting the drug. It can develop even at therapeutic doses. Dystonias associated with antiemetic drugs often show focal or segmental distribution. Parenteral biperiden is a fast and effective treatment option. Acute dystonia can mimic serious etiologies in the emergency department. Obtaining a detailed drug history can facilitate the diagnostic process.
Adult evidence for extracorporeal cardiopulmonary resuscitation (ECPR) is substantial, but to our knowledge, comparative studies for pediatric out-of-hospital cardiac arrest (OHCA) are lacking. We compared outcomes of pediatric OHCA with ECPR versus continued cardiopulmonary resuscitation (CPR). We conducted a retrospective cohort study of patients <18 years from a multicenter Japanese OHCA registry (2014 to 2022) transported to pediatric ECPR-capable institutions. Exposure was ECPR initiation versus continued CPR among patients at risk for ECPR (no ECPR yet; could receive ECPR later). Outcomes were one-month survival and favorable neurologic outcome (Pediatric Cerebral Performance Category 1 to 3). We applied risk-set matching with time-dependent propensity scores, using full matching with up to 4 controls per case. Of 799 patients, 27 received ECPR; 1:4 matching yielded 108 at-risk controls. ECPR patients were adolescents (median 14 years), witnessed arrest (70.4%), cardiogenic (74.1%); patient characteristics were similar after matching. In patients receiving ECPR versus controls, 1-month survival was 25.9% (7/27) versus 11.1% (12/108) (risk difference 17.3%; 95% confidence interval [CI], -0.9 to 35.6; risk ratio, 3.56; 95% CI, 1.37 to 9.28) and favorable neurologic outcome was 18.5% (5/27) versus 6.5% (7/108) (risk difference 13.9%; 95% CI, -2.9 to 30.8; risk ratio, 3.78; 95% CI; 1.19 to 11.99). Compared with continued conventional CPR among at-risk patients, ECPR might be associated with improved patient outcomes after pediatric OHCA, but the precision of estimates was limited, with wide confidence intervals. Interpretation is limited by the residual confounding inherent to an observational design; our findings can inform randomized trials of pediatric ECPR.
Emergency medicine (EM) residency curricula are designed to prepare future physicians for independent practice. Although the Accreditation Council for Graduate Medical Education requires that EM residents have prehospital experiences, very few programs augment this experience with a dedicated resident response vehicle. There are minimal data demonstrating the utility of such an approach. Our residency program staffs a dedicated response vehicle with a PGY-2/3 resident 24/7/365 to respond to high-acuity emergency medical services (EMS) calls. Additionally, from 0800 to 2300, the on-duty resident provides on-line medical control (OLMC) for the county. Each resident averages one 24-hour shift per 4-week EM block. The purpose of this study is to describe the prehospital educational experiences and curricular contributions that this program provides. We used a retrospective observational study design of administrative patient care records over a 5-year period. The primary outcomes were the number of unique encounters and patient experiences per resident per cohort year. The secondary outcomes included characterization of the prehospital experiences among all residents: physician role, patient age-group and sex, problem type, scene location, and procedures. Descriptive statistics were computed to quantify the number, type, and characteristics of the prehospital encounters. Ninety unique resident users were identified in the charting system. The mean number of encounters per resident was grouped by graduation year and spanned from 28.7 (SD 15) for 2018 to 79.2 (SD 49.2) for 2022, with a range of 2 to 222 encounters per resident documented. Over the study period, our residents managed 1313 out-of-hospital cardiac arrests (34 pediatric), 1048 refusals, 596 death pronouncements, 172 critical trauma patients, and answered 2053 complex OLMC consults. This study quantified the prehospital experiences of our senior EM residents with the addition of a physician response vehicle to our longitudinal EMS curriculum. This has allowed our residents to gain valuable first-hand exposure to out-of-hospital adult and pediatric cardiac arrests, refusals of care, altered mental status, and respiratory emergencies, in addition to prehospital scenarios not likely to be seen within the hospital walls, including motor vehicle collisions with entrapment and mass casualty incidents.
Emergency medicine (EM) requires proficiency in high-acuity, low-occurrence (HALO) procedures. Opportunities to perform these procedures often decline after training, potentially leading to skills attrition that can affect patient safety. There is currently no standard mechanism for maintenance of procedural skills for EM faculty. Based on a previously published needs assessment, we designed and implemented a skills maintenance curriculum for EM faculty: Emergency Medicine Faculty Interactive Training on Necessary Emergency Skills & Simulation (EM FITNESS). We invited EM faculty to participate in part or all of an optional two-year skills curriculum consisting of three modules: (1) airway, (2) cardiopulmonary procedures, and (3) obstetrics/pediatrics. Participants received pre-learning materials to maximize in-session, hands-on practice. Learners divided into small peer groups and practiced skills on simulation-based models under direct observation of instructors who were EM and non-EM faculty with content expertise (e.g., pediatric EM, ultrasound, obstetrics, neonatology). Participants completed pre-, post-, and 6-month surveys via REDCap to assess: frequency of performing or supervising procedures, curriculum effectiveness, confidence, attitudes pertaining to skills attrition, and opportunities for program improvement. Overall faculty participation across all three modules was 39.5%. Faculty performed or supervised about half of the HALO procedures at least once in the prior year, with supervision more common than performance. For nearly all procedures, there was an increase in self-reported confidence immediately post-training which declined at 6 months but remained above baseline. All faculty agreed that skills maintenance was important, and 83.6% reported experiencing skills attrition personally. A faculty-targeted, simulation-based curriculum produced sustained rates of confidence in performing HALO procedures. This study demonstrates the impact of a structured program and its association with increased self-reported confidence in HALO procedures among EM faculty. Future work will seek to refine, scale, and disseminate the curriculum and ultimately study its impact on clinical care.