360 - Pediatric Emergency Care Coordinators and Process of Care Measures in General Emergency Departments

Poster Number: 360
Publication Number: 360.167

Background: Higher pediatric readiness is associated with improved outcomes in the emergency department (ED), however readiness is variable across US EDs. The presence of a pediatric emergency care coordinator (PECC) is associated with higher readiness, yet it is unclear whether this may be due to the role of PECCs in pediatric quality improvement and adoption of evidence-based clinical care processes.

Objective: We sought to determine the association between PECC presence and process of care quality measures.

Design/Methods: We created a linked data set across 8 states, combining the 2019 National ED Inventory (NEDI-USA and HCUP State Emergency Department and Inpatient Databases, to assess two quality measures related to decreased use of radiation in pediatric imaging: use of chest x-ray (CXR) in asthma and head CT in head trauma. For each, we constructed multilevel generalized linear models to examine the association between PECC and measure performance, adjusted for patient-level factors (age, sex, race/ethnicity, insurance, and complex chronic condition (CCC)) and ED-level factors (visit volume and patient census quartiles of race, ethnicity, insurance, ≥1 CCC). We excluded freestanding pediatric hospitals. We stratified hospitals into (a) pediatric-resourced (pediatric intensive care or inpatient units) or (b) non-pediatric resourced.

Results: There were 209,565 patients with head trauma at 214 pediatric-resourced hospitals, and 139,603 patients at 513 non-pediatric-resourced hospitals; 218,371 patients with asthma at 214 resourced hospitals, and 88,541 patients at 505 non-resourced hospitals. After adjustment, the presence of a PECC was not significantly associated with odds of head CT among resourced hospitals, with a trend toward reduced use (aOR 0.85 [95%CI 0.73, 1.00]). PECC presence was associated with decreased odds of head CT among non-resourced hospitals (aOR 0.76 [95%CI 0.66, 0.87]). PECC presence was associated with decreased use of CXR for asthma in resourced hospitals (aOR 0.77 [95%CI 0.66, 0.91]), but not in non-resourced hospitals (aOR 0.93 [95%CI 0.78, 1.12]).

Conclusion(s): Presence of a PECC was significantly associated with decreased head CT use for head trauma among non-resourced hospitals and decreased CXR use for asthma in resourced hospitals. These data suggest potential influence of PECCs on clinical processes of care. Additional studies are needed to understand the role of PECCs in driving adherence to clinical evidence-based practice guidelines in pediatric emergency care.