Clinical Pathway–Based Pediatric Emergency Outreach Program: Implementation and Preliminary Evaluation
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".