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.  

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Janelle Ali-Dinar, PhD

Janelle Ali-Dinar, PhD is a rural healthcare expert and advocate with more than 15 years of healthcare executive experience in many key areas addressing critical access hospitals (CAHs), rural health clinics (RHCs), physicians, and patients. Dr. Ali-Dinar is a sought-after speaker on Capitol Hill. A former hospital CEO and regional rural strategy executive, Janelle is also a past National Rural Health Association rural fellow, Rural Congress member, and Nebraska Rural Health Association president. She is currently the Nebraska DHHS chair of The Office of Minority Health Statewide Council, addressing needs of rural, public, minority, tribal, and refugee health, and she serves on the Regional Health Equity Region VII council as co-chair of Rural Health and Partnerships. Janelle holds a master’s degree and doctorate in communications and is a recent graduate in public health leadership. Janelle is currently the vice president of rural health for MyGenetx and is a member of the RACmonitor editorial board.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →