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 Members21 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?

• 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

Pediatric ED Visits

• 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

National Pediatric Readiness Project

• 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

Purpose

• 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)

Collaboration

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

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

Instrument

• 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

Feedback

National Results

The National Picture

39%

30%

17%

14%

% EDs by Volume

< 5 children/day

5- 14 children/day

15-25 children/day

>25 children

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

Alan Frechette, MD

Toni Gross, MD

Anthony Huma

Kathy Karlberg, RN

Pamela Murphy, MD

Craig Norquist, MD

Kathy Northrop, RN

James Reingold, MD

Teresa Salama

Peggy Stemmler, MD

Tomi St. Mars, RN

Susan Thomas, RN

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