title: Differences in the Quality of Pediatric Resuscitative Care Across a Spectrum of Emergency Departments.
abstract: OBJECTIVE
  The quality of pediatric resuscitative care delivered across the spectrum of emergency departments (EDs) in the United States is poorly described. In a recent study, more than 4000 EDs completed the Pediatric Readiness Survey (PRS); however, the correlation of PRS scores with the quality of simulated or real patient care has not been described.
  
  
  OBJECTIVE
  To measure and compare the quality of resuscitative care delivered to simulated pediatric patients across a spectrum of EDs and to examine the correlation of PRS scores with quality measures.
  
  
  METHODS
  This prospective multicenter cohort study evaluated 58 interprofessional teams in their native pediatric or general ED resuscitation bays caring for a series of 3 simulated critically ill patients (sepsis, seizure, and cardiac arrest).
  
  
  METHODS
  A composite quality score (CQS) was measured as the sum of 4 domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. Pediatric Readiness Survey scores and health care professional demographics were collected as independent data. Correlations were explored between CQS and individual domain scores with PRS.
  
  
  RESULTS
  Overall, 58 teams from 30 hospitals participated (8 pediatric EDs [PEDs], 22 general EDs [GEDs]). The mean CQS was 71 (95% CI, 68-75); PEDs had a higher mean CQS (82; 95% CI, 79-85) vs GEDs (66; 95% CI, 63-69) and outperformed GEDs in all domains. However, when using generalized estimating equations to estimate CQS controlling for clustering of the data, PED status did not explain a higher CQS (β = 4.28; 95% CI, -4.58 to 13.13) while the log of pediatric patient volume did explain a higher CQS (β = 9.57; 95% CI, 2.64-16.49). The correlation of CQS to PRS was moderate (r = 0.51; P < .001). The correlation was weak for cardiac arrest (r = 0.24; P = .07), weak for sepsis (ρ = 0.45; P < .001) and seizure (ρ = 0.43; P = .001), and strong for teamwork (ρ = 0.71; P < .001).
  
  
  CONCLUSIONS
  This multicenter study noted significant differences in the quality of simulated pediatric resuscitative care across a spectrum of EDs. The CQS was higher in PEDs compared with GEDs. However, when controlling for pediatric patient volume and other variables in a multivariable model, PED status does not explain a higher CQS while pediatric patient volume does. The correlation of the PRS was moderate for simulation-based measures of quality.
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors: Marc
authors: M
authors: Auerbach
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors: Travis
authors: T
authors: Whitfill
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors: Marcie
authors: M
authors: Gawel
authors: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors: David
authors: D
authors: Kessler
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Massachusetts Medical Center, Worcester.
authors: Barbara
authors: B
authors: Walsh
authors: Division of Critical Care Medicine, Department of Pediatrics, Long Island Jewish Medical Center, New Hyde Park, New York.
authors: Sandeep
authors: S
authors: Gangadharan
authors: Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Melinda Fiedor
authors: MF
authors: Hamilton
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors: Brian
authors: B
authors: Schultz
authors: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia.
authors: Akira
authors: A
authors: Nishisaki
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia.
authors: Khoon-Yen
authors: KY
authors: Tay
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia.
authors: Megan
authors: M
authors: Lavoie
authors: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Jessica
authors: J
authors: Katznelson
authors: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Robert
authors: R
authors: Dudas
authors: Department of Emergency Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island.
authors: Janette
authors: J
authors: Baird
authors: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia.
authors: Vinay
authors: V
authors: Nadkarni
authors: Department of Emergency Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island.
authors: Linda
authors: L
authors: Brown
mesh_terms: D001291:Attitude of Health Personnel; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000628:therapy*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards*; D012151:Resuscitation / Q000592:standards*; D012640:Seizures / Q000628:therapy*; D018805:Sepsis / Q000628:therapy*