Clinical Pathway–Based Pediatric Emergency Outreach Program: Implementation and Preliminary Evaluation
Notice bibliographique
Résumé
Pediatric patients represent about 25% of emergency department (ED) visits in Ontario. Although pediatric EDs work to ensure best-evidence care in their settings, most pediatric visits occur outside these centres. In fact, more than 80% of Ontario pediatric emergency visits occur in general hospital EDs, representing over 800 000 visits to sites that are less likely to have pediatric expertise, medications, equipment, and policies in place. Health care professionals in these settings may be less comfortable delivering pediatric care because of limited training or because they lack familiarity with pediatric medications and dosing. Even though children might receive better care from pediatric subspecialists, their care will continue to be provided in general EDs. All children should receive quality emergency care, regardless of where they present. The Children’s Hospital of Eastern Ontario (CHEO), a large academic general hospital, and 14 community hospitals lie within the geographic region of the Champlain Local Health Integrated Network (LHIN). In 2012/2013, CHEO had 66 051 ED visits and 6245 admissions. Beyond CHEO, pediatric expertise is limited within this LHIN, as the other centres have less or no access to in-house pediatric consultants. However, pediatric visits account for 15%–40% of ED visits at these community hospitals, and 2 of the sites admit pediatric patients. In 2007, funding was received for a 1-year project to develop and implement an outreach program with the goal of helping nonpediatric health care professionals to deliver standardized, evidence-based pediatric emergency care across the Champlain LHIN. The outreach program focused on using clinical pathways for a set of common pediatric conditions seen in the ED. A clinical pathway is a tool to operationalize best-evidence guidelines into accessible bedside formats for health care provider teams. To support the use of clinical pathways, health care professionals were offered education workshops, delivered by an interprofessional ED team, and auxiliary resources through an outreach website. With judicious budgeting and ongoing interest, the outreach program has continued for 6 additional years. To formally assess the program’s impact, grant funding was secured in 2010 to conduct a mixed-methods program evaluation. This report describes the ED Outreach Program and preliminary evaluation results, specifically participant satisfaction with the educational workshops and results of knowledge tests conducted before and after the workshop (pre/post tests). Subsequent evaluation findings, including qualitative interviews, pre/post chart audits, and the benefits, harms, failures, and unanticipated outcomes of the program, will be reported in a subsequent paper.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».