Pediatric Readiness and Quality Improvement for Critical Access Hospitals: A Call for Action

National Pediatric Readiness Quality Collaborative announced for rural healthcare.

We all know that rural healthcare desperately needs pediatricians and pediatric services, so an opportunity currently exists to champion high-quality care for rural children.

What is that opportunity? The Emergency Medical Services for Children Program at HRSA has extended the deadline for critical access hospitals (CAHs) to submit a letter of interest, pushing the date to Oct. 13, 2017.  Each participating CAH selected will receive mentoring from the Pediatric Readiness Quality Collaborative (PRQC). Additionally, physicians will earn Maintenance of Certification Part IV credit and nurses will receive Continuing Nursing Education credit for program initiative completion.

Rural Program Elements

The PRQC initiative will focus on pediatric patient safety, transfer guidelines, inter-facility transfer guidelines, patient assessments, and disaster preparedness. An added feature is the “train-the-trainer model,” in which teams will be supported through the provision of tools and resources for local capacity building efforts, sharing of best practices, and targeted quality improvement education.  

PRQC: How it Began

In order to ensure high-quality emergency care for children regardless of their respective geographic location, the Emergency Medical Services for Children (EMSC) program, in collaboration with the American Academy of Pediatrics, the Emergency Nurses Association, and the American College of Emergency Physicians, in 2013 launched the National Pediatric Readiness Project (NPRP).  The first step was the design and dissemination of a national assessment based on the 2009 Guidelines for Care of Children in the Emergency Department. The goal was to assess or determine the capacity of our nation’s emergency departments to meet the needs of children. 

By 2013, the National Pediatric Readiness Assessment had an impressive 83 percent participation among emergency departments, leading to the conclusion that there was a clear-cut need for high-quality emergency care for children across the nation.  

National Gaps Identified

The readiness assessment, however, revealed  the following issues identified by participants:

1. Process to ensure pediatric weights are measured in kilograms (67.7 percent);
2. Presence of inter-facility transfer guidelines (70.6 percent);
3. Presence of disaster plans that include pediatric-specific needs (46.8 percent);
4. Presence of physician (47.5 percent) and nurse (59.3 percent) pediatric emergency care coordinators (PECC); and
5. Presence of quality improvement (QI) plans that include children (45.1 percent).

Common Reported Barriers

• Lack of educational resources
• Lack of a QI plan for children 
• Cost of training personnel       
   

Rural Impact

A startling issue was the finding that 69.4 percent of children seeking emergency care are cared for in emergency departments that see fewer than 15 pediatric patients per day; these include CAHs and community emergency departments.

Even in low-volume pediatric facilities, the presence of a pediatric champion (PC) significantly improved pediatric readiness. Also noted was that the presence of a QI plan that included pediatric-specific indicators was found to be independently associated with improved overall readiness.

HRSA & EIIC Partner for Children Needs

To champion the crucial needs of children receiving emergency treatment, the Health Resources and Services Administration (HRSA), in collaboration with the EMS for Children Innovation and Improvement Center (EIIC), are sponsoring a national quality improvement collaborative that aligns with the Institute for Healthcare Improvement’s Breakthrough Series collaborative model to foster evidence-based guidelines that will result in short-term improvements for patients. 

Based on results of the assessment as outlined, the EIIC will launch the first National Pediatric Readiness Quality Collaborative to help support efforts in states and territories at the local level to meet the quality emergency care needs of children. 

In order to improve quality of care provided to pediatric patients across the nation, the invitation goal for the Pediatric Readiness Quality Collaborative will include 20 teams (20 training sites) and between 160-240 affiliate sites.

Participants will be supported through targeted quality improvement education, the provision of tools and resources to support local efforts, and sharing of best practices using a train-the-trainer model.

Collaborative Initiative Curriculum

The QI training will include strategies to identify needs assessments/gaps in care; developing key driver diagrams; creating specific, measurable, achievable, relevant and time-bound (SMART) aims; integrating QI tools including strengths, weaknesses, opportunities, and threats (SWOT) analysis; designing fishbone diagrams and process maps; and finally, identifying sustainability opportunities and dissemination techniques.

The collaborative design will focus on the following topics, and each intervention will form the basis for local and regional quality improvement efforts as part of the collaborative activities:

• A patient safety initiative focused on collecting and documenting pediatric patients’ weight in kilograms.
• Developing a notification process for abnormal vital signs.
• Establishing disaster plans that include children. 
• Ensuring inter-facility transfer guidelines are patient- and family-centered.
• Additionally, each trainer will work with pediatric champions at each of the affiliate sites to develop and implement QI plans targeting key gaps in pediatric readiness. 

PRQC: How to Participate

• Join the PRQC mailing list:

https://tch-redcap.texaschildrens.org/REDCap/surveys/?s=E8AN4TPFDM 

• Provide a statement of interest (Due Oct.13) and formal application (Due Oct. 31):

https://tch-redcap.texaschildrens.org/REDCap/surveys/?s=FJF3FNTEFA

• Download the Application Guidebook:

PRQC Workbook_v2.pdf

Additional Resources:

For more information about the Pediatric Readiness Quality Improvement Collaborative, check out the following:

https://emscimprovement.center/collaboratives/PRQuality-collaborative/ 

Additional questions can be directed to qeca@texaschildrens.org. Also, to view the introductory webinar, visit:

https://hrsaseminar.adobeconnect.com/pzss0f1pgfx5

PRQC Aims

The PRQC goal is for 20 states or territory teams to collectively improve their pediatric readiness scores by 10 points by December 2019.

The bottom-line is that rural healthcare is about collaboration, and collaborative initiatives provide an effective and vital method to integrating best practices and evidence-based guidelines. The inclusion of a deemed “quality improvement collaborative” further reinforces the need for, and effectiveness of, utilizing teams that can learn from one another, use collective data, discuss changes necessary to improve quality, test these methods, and then be able to have access to the necessary tools to implement best practices and then adapt and duplicate the model.  

This is an excellent opportunity to advance quality care for our children of today, who are our hope of tomorrow.