Assignment: High-fidelity Simulation

Assignment: High-fidelity Simulation

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Assignment: High-fidelity Simulation

The EMSC federal program has recently supported a conversion of its coordinating center to one embedded in improvement science (EMSC Innovation and Improvement Center), of which its initiatives includes efforts to minimize unwanted variation in care (www.EMSCImprovement.center). One such initiative includes a partnership with the American Academy of Pediatrics for development of national ED- based evidence-based pathways. To date, these have included publically accessible pathways for septic shock, bronchiolitis, and community acquired pneumonia.49Hospital-based efforts are currently limited by gaps in data sharing across institutions to evaluate outcomes and costs related to implementation of these pathways. However, local implementation of these and other evidence-based clinical standards products will likely continue to describe the value of clinical standards in pockets across the EMSC continuum. The Pediatric Initiative for Clinical Standards (PICS), now in its second year, is moving from its development of hospital-based guidelines activities within this consortium of children’s hospitals to a phase of data collection on quality metrics in order to demonstrate value in clinical standards implementation that will include components of ED based care.

Although limitations to big data sharing will continue to limit the nation’s ability to demonstrate the aggregate value in clinical standards across the EMSC continuum, demonstrated successes in defining value for components of the system will fuel more comprehensive and widespread approaches to development and implementation. Ultimately, these patient centric approaches to clinical standards work will continue to drive improved outcomes of care, a better patient experience, and decreased costs of care–achieving the triple aim.

Acknowledgements

Travis L. Rodkey, Ph.D., Outcomes Analyst, Outcomes and Impact Service, Texas Children’s Hospital, Houston, TX.

References

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2 M.E. Porter, E.O. Teisberg, Redefining health care: creating value-based competition on results, 2006, Harvard Business School Press, Boston, MA

3 K.N. Lohr, S.A. Schroeder, A strategy for quality assurance in Medicare, N Engl J Med, Vol. 322, 1990, 707-712

4 C.E. Chumpitazi, P. Barrera, C.G. Macias, Diagnostic accuracy and therapeutic reliability in pediatric emergency medicine: the role of evidence-based guidelines, Clin Pediatr Emerg Med, Vol. 12, 2011, 113-120

5 D.M. Berwick, T.W. Nolan, J. Whittington, The triple aim: care, health, and cost, Health Aff, Vol. 27, 2008, 759-769

6 C.W. Kang, P.H. Kvam, Basic statistical tools for improving quality, 2011, John Wiley & Sons, Hoboken, NJ

7 M.I. Shah, J.M. Carey, S.E. Rapp, Impact of high-fidelity simulation on paramedic seizure management, Prehosp Emerg Care, Vol. 20, 2016, 499-507

8 N.E. Wang, O. Saynina, K. Kuntz-Duriseti, Variability in pediatric utilization of trauma facilities in California: 1999 to 2005, Ann Emerg Med, Vol. 52, 2008, 607-615

9 A.B. Kharbanda, M. Hall, S.S. Shah, Variation in resource utilization across a national sample of pediatric emergency departments, J Pediatr, Vol. 163, 2013, 230-236

10 C.G. Macias, J.M. Mansbach, E.S. Fisher, Variability in inpatient management of children hospitalized with bronchiolitis, Acad Pediatr, Vol. 15, 2015, 69-76

11 E.J. Andrews, H.P. Redmond, A review of clinical guidelines, Br J Surg, Vol. 91, 2004, 956-964

12 J.L. Wright, Evidence-based guidelines for prehospital practice: a process whose time has come, Prehosp Emerg Care, Vol. 18, 2014, 1-2

13 M.R. Sayre, L.J. White, L.H. Brown, National EMS research agenda, Prehosp Emerg Care, Vol. 6, 2002, 1-43

14 C. Martin-Gill, J.B. Gaither, B.L. Bigham, National prehospital evidence-based guidelines strategy: a summary for EMS stakeholders, Prehosp Emerg Care, Vol. 20, 2016, 175-183

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