Browsing by Author "Montgomery, Erin E."

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    Improving Emergency Preparedness in Pediatric Primary Care Offices: A Simulation-Based Interventional Study
    (Academic Pediatric Association, 2022-09) Yuknis, Matthew L.; Abulebda, Kamal; Whitfill, Travis; Pearson, Kellie J.; Montgomery, Erin E.; Auerbach, Marc A.; Pediatrics, School of Medicine
    Objectives Pediatric emergencies pose a challenge to primary care practices due to irregular frequency and complexity. Simulation-based assessment can improve skills and comfort in emergencies. Our aim was improving pediatric office emergency preparedness, as measured by adherence to the existing American Academy of Pediatrics policy statement, and quality of emergency care in a simulated setting, as measured by performance checklists. Methods This was a single center study nested in a multicenter, prospective study measuring emergency preparedness and quality of care in 16 pediatric primary care practices and consisted of 3 phases: baseline assessment, intervention, and follow-up assessment. Baseline emergency preparedness was measured by checklist based on AAP guidelines, and quality of care was assessed using in-situ simulation. A report-out was provided along with resources addressing potential areas for improvement after baseline assessment. A repeat preparedness and simulation assessment was performed after a 6 to 10 month intervention period to measure improvement from baseline. Results Sixteen offices were recruited with 13 completing baseline and follow-up preparedness assessment. Eight of these sites also completed baseline and follow-up simulation assessment. Median baseline preparedness score was 70% and follow-up was 75.9%. Median baseline simulation performance scores were 37.4% and 35.5% for respiratory distress and seizure scenarios, respectively. Follow-up simulation assessment scores were 73% and 76.9% respectively (P = .001). Conclusions Our collaborative was able to successfully improve the quality of care in a simulated setting in a group of pediatric primary care offices over 6 to 10 months. Future work will focus on expansion and improving emergency preparedness.
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    Preparedness for Pediatric Office Emergencies: A Multicenter, Simulation-Based Study
    (AAP, 2021-09) Abulebda, Kamal; Yuknis, Matthew L.; Whitfill, Travis; Montgomery, Erin E.; Pearson, Kellie J.; Rousseau, Rosa; Diaz, Maria Carmen G.; Brown, Linda L.; Wing, Robyn; Tay, Khoon-Yen; Good, Grace L.; Malik, Rabia N.; Garrow, Amanda L.; Zaveri, Pavan P.; Thomas, Eileen; Makharashvili, Ana; Burns, Rebekah A.; Lavoie, Megan; Auerbach, Marc A.; Improving Pediatric Acute Care Through Simulation (ImPACTS); Pediatrics, School of Medicine
    OBJECTIVES Pediatric emergencies can occur in pediatric primary care offices. However, few studies have measured emergency preparedness, or the processes of emergency care, provided in the pediatric office setting. In this study, we aimed to measure emergency preparedness and care in a national cohort of pediatric offices. METHODS This was a multicenter study conducted over 15 months. Emergency preparedness scores were calculated as a percentage adherence to 2 checklists on the basis of the American Academy of Pediatrics guidelines (essential equipment and supplies and policies and protocols checklists). To measure the quality of emergency care, we recruited office teams for simulation sessions consisting of 2 patients: a child with respiratory distress and a child with a seizure. An unweighted percentage of adherence to checklists for each case was calculated. RESULTS Forty-eight teams from 42 offices across 9 states participated. The mean emergency preparedness score was 74.7% (SD: 12.9). The mean essential equipment and supplies subscore was 82.2% (SD: 15.1), and the mean policies and protocols subscore was 57.1% (SD: 25.6). Multivariable analyses revealed that independent practices and smaller total staff size were associated with lower preparedness. The median asthma case performance score was 63.6% (interquartile range: 43.2–81.2), whereas the median seizure case score was 69.2% (interquartile range: 46.2–80.8). Offices that had a standardized process of contacting emergency medical services (EMS) had a higher rate of activating EMS during the simulations. CONCLUSIONS Pediatric office preparedness remains suboptimal in a multicenter cohort, especially in smaller, independent practices. Academic and community partnerships using simulation can help address gaps and implement important processes like contacting EMS.
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    Quality of Resuscitative Care Provided to an Infant with Abusive Head Trauma in Community Emergency Departments: An In Situ, Prospective Simulation-Based Study
    (Wolters Kluwer, 2022-01) Lutfi, Riad; Berrens, Zachary J.; Ackerman, Laurie L.; Montgomery, Erin E.; Mustafa, Manahil; Kirby, Michele L.; Pearson, Kellie J.; Abu-Sultaneh, Samer; Abulebda, Kamal; Pediatrics, School of Medicine
    Objectives Abusive head trauma (AHT) is a very common and serious form of physical abuse, and a major cause of mortality and morbidity for young children. Early Recognition and supportive care of children with AHT is a common challenge in community emergency department (CEDs). We hypothesized that standardized, in situ simulation can be used to measure and compare the quality of resuscitative measures provided to children with AHT in a diverse set of CEDs. Methods This prospective, simulation-based study measured teams' performance across CEDs. The primary outcome was overall adherence to AHT using a 15-item performance assessment checklist based on the number of tasks performed correctly on the checklist. Results Fifty-three multiprofessional teams from 18 CEDs participated in the study. Of 270 participants, 20.7% were physicians, 65.2% registered nurses, and 14.1% were other providers. Out of all tasks, assessment of airway/breathing was the most successfully conducted task by 53/53 teams (100%). Although 43/53 teams (81%) verbalized the suspicion for AHT, only 21 (39.6%) of 53 teams used hyperosmolar agent, 4 (7.5%) of 53 teams applied cervical spine collar stabilization, and 6 (11.3%) of 53 teams raised the head of the bed. No significant difference in adherence to the checklist was found in the CEDs with an inpatient pediatric service or these with designated adult trauma centers compared with CEDs without. Community emergency departments closer to the main academic center outperformed CEDs these that are further away. Conclusions This study used in situ simulation to describe quality of resuscitative care provided to an infant presenting with AHT across a diverse set of CEDs, revealing variability in the initial recognition and stabilizing efforts and provided and targets for improvement. Future interventions focusing on reducing these gaps could improve the performance of CED providers and lead to improved patient outcomes.