Children with potentially life-threatening illnesses are sometimes taken to primary care offices, which often serve as the child’s medical home. Estimates of how often emergently ill children are taken to primary care offices vary widely, with numbers ranging from 1-2 a year to up to multiple patients seen weekly. While the frequency of these events remains somewhat in question, it is well established that pediatric primary care offices are ill prepared to care for emergencies, with multiple studies reporting wide variation in the available equipment, supplies, and level of preparedness for these patients despite the existence of established recommendations from the American Academy of Pediatrics (AAP).
ImPACTS (Improving Pediatric Acute Care through Simulation) is a research and education network that aims to improve pediatric readiness and structure of care in the United States. They have established an effective educational model in community emergency departments with AMCs serving as “HUBS” and community hospitals as “SPOKES.” We seek to adapt this study design and methodology with community pediatric primary care practices serving as “SPOKES.” Each primary care practice will designate a champion to facilitate participation in the ImPACTS program. These champions will lead their emergency readiness improvement efforts over the duration of the study, with support from the HUB and ImPACTS coordinating center. The intervention begins with an in-person emergency readiness assessment. This assessment involves a survey of the primary care practice (see below in methods) as well as a simulation-based assessment of the quality of care delivered to a set of simulated patients in either the patient rooms or waiting room of the practice. A performance report and gap analysis will be generated from the survey and simulation data by the ImPACTS team. After presenting these findings to the site, the group will select two high priority “ImPACTS action items for improvement.” At the end of a six month period, a follow-up emergency readiness assessment day will be completed. The goal of this collaborative is for each of the participating spokes to complete the action items and improve the practice’s emergency readiness score by 10%. By implementing these interventions, we aim to:
1. Evaluate the impact of our intervention on the emergency preparedness of participating pediatric primary care practices as measured by percent adherence to an emergency readiness checklist based on existing AAP guidelines.
2. To evaluate the impact of our intervention on the structure and process of care provided to simulated emergently ill patients in pediatric outpatient offices.