A Survey Assessment of Perceived Importance and Methods of Maintenance of Critical Procedural Skills in Pediatric Emergency Medicine

• Published in: Pediatric emergency care Vol. 35; no. 8; pp. 552 - 557
• Main Authors: Mittiga, Matthew R, FitzGerald, Michael R, Kerrey, Benjamin T
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-08-2019
• Subjects: Attitude of Health Personnel; Child; Clinical Competence - statistics & numerical data; Critical Care - methods; Critical Care - trends; Cross-Sectional Studies; Education, Medical, Graduate - economics; Electric Countershock - statistics & numerical data; Emergency Medicine - education; Hospitals, Pediatric - statistics & numerical data; Humans; Intubation, Intratracheal - statistics & numerical data; Pediatric Emergency Medicine - economics; Pediatric Emergency Medicine - education; Perception - physiology; Surveys and Questionnaires; Thoracostomy - statistics & numerical data; United States - epidemiology; United States
• ISSN: 0749-5161; 1535-1815
• DOI: 10.1097/PEC.0000000000000991

OBJECTIVEThe aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skillsoral endotracheal intubation, intraosseous line placement, pharmacologic and electrical cardioversion, tube thoracostomy, and defibrillation.
METHODSA customized survey was administered to all members of the Listserv for the American Academy of Pediatrics Section on Emergency Medicine. Perceived importance of maintaining critical pediatric procedural skills was measured using a 5-point Likert-type scale. Secondary outcomes included presence and type of mandatory training, availability of on-site backup, and perceived barriers to maintenance of skills.
RESULTSTwo hundred sixty-two members (25%) responded representing 106 different institutions, 70% of freestanding children’s hospitals that received graduate medical education payments in 2014, and 68% of pediatric emergency medicine fellowship programs. More than 90% of respondents felt it was either very or extremely important to maintain competency for 5 of the 6 critical procedures, but no more than 49% of respondents felt that clinical care alone provided opportunity to maintain skills. The proportion of respondents indicating no mandatory training for each critical procedural skill was as followsoral endotracheal intubation (23%), intraosseous line placement (30%), pharmacologic cardioversion (32%), electrical cardioversion (32%), tube thoracostomy (40%), and defibrillation (32%).
CONCLUSIONSCritical procedural skills are perceived by emergency providers who care for children as extremely important to maintain. Direct care of pediatric patients likely does not provide sufficient opportunity to maintain these skills. There are widespread deficiencies relating to mandatory maintenance of critical procedural skill training.