Future of Emergency Care Dissemination Workshop Summaries (2007) / Chapter Skim
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3 Workshop in Salt Lake City, Utah
3 Workshop in Salt Lake City, Utah
Pages 14-34
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From page 14... ...
Following the opening remarks by Dr. Clark, three IOM committee members, Nels Sanddal, Brent Eastman, and Marianne Gausche-Hill, provided an overview of the findings and recommendations from the three IOM reports.
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Years later, when Dr. Sundwall was working in Washington, DC, for Senator Orrin Hatch, he met another congressional staff member who had a poor experience with the pediatric emergency care system.
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Nonprofessional health care workers may also play an important role in preparedness. On September 11, 2001, non-health care professionals stood beside police, emergency medical services (EMS)
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Respondents included Paul Patrick, director of EMS for the State of Utah; Janet Griffith Kastl, director of the Office of EMS and Trauma for the State of Washington; James Antinori, an emergency physician in Salt Lake City; Denise King, director of education at Parkview Community Hospital in Southern California; and Joseph Hansen, executive director of the Critical Illness and Trauma Foundation in Bozeman, Montana. What Are the Key Messages of the IOM Reports?
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Ms. King noted that although the IOM reports address the nursing workforce shortage, they do not include any concrete recommendations for a solution to the problem.
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Mr. Sanddal agreed, noting that there should be some exploration of alternative training models for health care providers in rural areas, including the use of simulation training, which is discussed in the IOM reports.
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LEADING CHANGE Brent James, executive director of the Institute for Health Care Delivery Research, Intermountain Health Care, delivered the luncheon address and discussed health care quality and the need for providers to take an active role in improving emergency care.
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One of the best illustrations of that literature comes from Beth McGlynn, who looked at injuries of omission and commission in six major metropolitan areas and found that American health care provides appropriate care about 54.9 percent of the time. The literature on health care quality presents a picture of failure, and the IOM reports on emergency care provide even more evidence of failure.
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From page 22... ...
In the area of training and skills maintenance, the IOM committee recommended that every health professional credentialing and certification body related to pediatric emergency care define pediatric emergency core competencies and require practitioners to receive the appropriate level of initial and continuing education necessary to achieve and maintain those competencies. There continues to be great variability in the pediatric training and continuing education that prehospital providers receive.
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EMS-C coordinators may also be able to influence the state EMS directors to mandate pediatric coordinators at the agency level. The IOM committee also recommended the development of evidencebased model pediatric protocols for pediatric prehospital care.
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Dr. Frush noted that a national patient safety organization for pediatric emergency care is needed to allow providers to submit stories and share lessons learned.
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If, as the IOM committee recommended, patients and family members should be integrated into the care team, providers need to learn how to communicate these messages. Research Although there have been tremendous strides in pediatric emergency care in previous decades, many gaps remain and pediatric research continues to lag behind adult research.
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An example of a multicenter research network is the Pediatric Emergency Care Applied Research Network, which is funded by the EMS-C program of the Maternal and Child Health Bureau at HRSA. It is the first federally funded research network focused on pediatric emergency care.
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From page 27... ...
As a result of these challenges, the IOM committee recommended that every health professional credentialing and certification body related to pediatric emergency care define pediatric emergency core competencies and require practitioners to receive the appropriate level of initial and continuing education necessary to achieve and maintain those competencies. This recommendation is a first step toward the creation of core competencies that are essential for emergency care providers at different levels.
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Dr. Gausche-Hill responded by saying that the evaluation was critical because the program could not demonstrate measurable improvements in the outcomes of pediatric emergency care that could be attributed specifically to the program.
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One of the complicating factors in rural areas is that many rural hospitals have closed or have converted to Critical Access Hospitals with limited inpatient capacity. In addition, some rural facilities do not accept pediatric inpatients, making it very difficult to quickly place such patients.
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Dr. Ellenbogen emphasized that although the IOM reports focused on trauma care, neurosurgeons also provide a great deal of generalized specialty care in the ED because specialists are in short supply in rural areas.
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Currently it is impossible to transfer images from one hospital to another. The Perspective of a State EMS Official Dia Gainor, chief of the Emergency Medical Services Bureau for the Idaho Department of Health and Welfare, spoke about the roles of state EMS agencies and their capacity to introduce change to improve EMS and related emergency health care systems.
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Dr. Tilden also discussed the federal Rural Hospital Flexibility Program, which allows cost-based reimbursement for critical access hospitals and EMS providers so long as they are 35 miles from another facility.
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Tilden discussed the need for the Rural and EMS Trauma Technical Assistance Center to be refunded to work with state offices of rural health and promote EMS activity at the state level. Open Discussion Several members of the audience made comments or raised questions about the rural workforce.
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From page 34... ...
Special interest groups often emphasize deficiencies of the rural workforce in terms of their ability to care for certain types of patients, for example, children or trauma victims. The rural workforce has close connections to the community and needs to be viewed as a partner rather than providers that need to be "saved from themselves." Thomas Foley from the American College of Surgeons' Rural Trauma Committee described the Rural Trauma Development Course, which brings together all providers who care for trauma victims in a rural community, including prehospital providers, and provides direction on how to manage care during "the golden hour," the 60 minutes after the occurrence of trauma during which a victim's chances of survival with definitive care are greatest.
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