2007 Report -

1. A Partnership between the Arizona Department of Health Services, The Arizona Chapter – AAP, and Arizona Hospitals

2. 2007 Report - Pediatric treatment patterns vary widely among emergency care providers 6% of EDs in the US have all of the supplies deemed essential for managing pediatric emergencies Many providers undertreat children, many fail to recognize cases of child abuse Only half of hospitals have at least 85% of those supplies

3. EMS for Children – call to arms

4. Pediatric Prepared Emergency Care • April 2008 Stakeholder Meeting – Hospital CEOs, Emergency Department Leadership • 2008 – 2010 Stakeholder Committee Meetings – review and refine criteria • Late 2010 Program transferred to AzAAP, Formal Steering Committee seated • December 2011 Initial site visits • March 2012 7 Advanced Care sites, 2 Prepared Plus sites certified by AzAAP Board November 2014 31 Hospital Members 21 Hospital EDs certified , 2 pending approval

5. AZ Goal – Inclusive Regionalized System of Care Voluntary System Developed by ED Nurses and Physicians Oversight is by the American Academy of Pediatrics AZ Chapter • Three tiers – • Advanced Care • Prepared Plus Care • Prepared Care Sustainability: Membership and Certification Fees Consultation and Education

6. Levels of Care – Names not Numbers • Certification is available for three levels of care- the hospital decides what level to apply for: • Prepared Care - This level of certification provides services for pediatric care as part of a general Emergency Department.  The hospital refers critically ill or injured children to other facilities and may or may not have pediatric inpatient services available. M$1500/C$1000 • Prepared Plus Care - This level of certificationprovides services for most pediatric emergency care. The hospital may have a focus on pediatrics, but ICU services for children are not available.  M$2000/C$1500 • Prepared Advanced Care -This level of certification provides services for all levels of pediatric emergency care.  This hospital system includes a Pediatric intensive care unit and has a specific focus on pediatric services. M $2500/C$2000

7. WIIFM? • Members discussion forum • members share guidelines, procedures, issues and questions • Free educational classes and trainings • Certified Emergency Nurse Review Courses • Emergency Nursing Pediatric Courses • COMING SOON – Advanced Pediatric Life Support, Newborn Resuscitation Program and/or STABLE • Identification and action on issues common to most or all EDs • Site visit participants share learning

8. Regionalization work in other states • State Partnership for Regionalization of Care (SPROC) • To get the right resources to the right patient at the right time • AK - increasing pediatric focus in a variety of programs, including disaster preparedness, trauma, gen training, and regionalized care • AZ – Expand PPEC into rural and tribal communities, integrate evidence-based guidelines into clinical decision-making • CA - North Coast EMS, UC Davis, IHS, focus on evidence-based emergency medical services, including transport or telemedicine; education • MT – implement the Montana Inclusive Model of Pediatric Emergent Care, focusing on acutely ill and severely injured children • NM – interface between community focus – community readiness, EMS, and helping facilities to get them ready to manage pediatric emergencies • PA – Focusing on western PA and building collaboration/relationships between academic center and rural community health providers. • State Regionalization Systems • Illinois, Tennessee, CA (regions), Maryland, Oklahoma

9. Measurement/Systems

10. Why Pediatric Readiness?

11. Pediatric ED Visits • Children constitute 1/4 of all ED visits • Most children seek care in local community ED • Children usually arrive in personal vehicle • 82.7% of Nation’s EDs want to become Pediatric Ready

12. National Pediatric Readiness Project • Multi-phase quality improvement initiative • Based on Joint Policy Statement: Guidelines for the Care of Children in the Emergency Department • Self-assessment with immediate feedback • Benchmarking in groups by pediatric volume • Access to QI resources targeted to identified need

13. Purpose • Establish a baseline of nation’s capacity to provide pediatric emergency care in the ED • Create a foundation for QI process • Includes implementation of Joint Policy Statement • Develop benchmarks to measure improvement over time

14. Collaboration • Federal EMS for Children Program (HRSA-MCHB) • American Academy of Pediatrics (AAP) • American Academy of Emergency Physicians (ACEP) • Emergency Nurses Association (ENA) • EMS for Children National Resource Center (NRC) • National EMS for Children Data Analysis Resource Center (NEDARC)

15. The Assessment

16. Goal • To assess every emergency department (ED) in the nation • Over 5000 facilities identified by • The 2009 American Hospital Association Healthcare Dataview • EMS for Children State Partnership grantees

17. Instrument The National Pediatric Readiness Assessmentincludes questions that address the following areas of the Joint Policy Statement: • Administration and Coordination • Physician, Nurses, and Other ED Staff • QI/PI in the ED • Pediatric Patient Safety • Policies, Procedures, and Protocols • Equipment, Supplies and Medications

18. Feedback • Respondents received immediate feedback: • Readiness Score • based on 6 areas of Joint Policy Statement • Weighted scores on scale of 0-100 • Compared with similar pediatric volumes and all facilities • Gap analysis report • Individualized summary of strengths and weakness • Directed respondent to targeted components in the Pediatric Readiness Toolkit • Suggested starting point; not all inclusive

19. National Results

20. The National Picture

21. Quality and Process Improvement helps to ensure: • Processes are in place to review clinical cases • Data is gathered to measure deviation from best practices or errors in care • Use of appropriate metrics to evaluate and improve health outcomes of children • Integration with other QI committees for the coordination of care throughout the medical continuum

22. Guidelines for Improving Pediatric Patient Safety in the ED help to ensures: • Polices and practices are in place to address unique pediatric patient safety concerns Note: The delivery of pediatric care reflects an awareness of the unique needs to improve health outcomes of children.

23. Guidelines for Equipment, Supplies, and Medication for the care of Pediatric Patients helps ensure: • Availability and accessible for all ages and sizes • Equipment, supplies, and medication are logically and safely organized • Staff are educated on location and function of all equipment and supplies • Daily verification/check list process is in place for all equipment and supplies

24. Members • Arizona Children's Center at Maricopa Medical Center • Banner Baywood Medical Center • Banner Boswell Medical Center • Banner Del E. Webb Medical Center • Banner Estrella Medical Center • Banner Gateway Medical Center • Banner Ironwood Medical Center • Banner Page Hospital • Banner Thunderbird Medical Center • Benson Hospital • Cardon’s Children’s Medical Center • Cobre Valley Regional Medical Center • Chinle Comprehensive Health Care Facility • Copper Queen Community Hospital • Gila River Hu HuKam Memorial Hospital • John C. Lincoln Deer Valley Hospital- Mendy's Place • Northern Cochise Community Hospital • Oro Valley Hospital • Parker Indian Health Center • Phoenix Baptist Hospital • Phoenix Children’s Hospital • Scottsdale Healthcare- Osborn Medical Center • Scottsdale Healthcare- Shea Medical Center • Scottsdale Healthcare- Thompson Peak Medical Center • Summit Healthcare Regional Medical Center • Tuba City Regional Health Care • Tucson Medical Center for Children • University of Arizona Medical Center- Diamond Children’s Medical Center • Verde Valley Medical Center • White Mountain Regional Medical Center • Yuma Regional Medical Center

25. Shared Learning

29. Relationships then Partnerships Lead to Practice Change • Criteria changes occur every 3 years • Based on new evidence and is concensus • Wins – • Weights in kilograms • Improved child abuse policies • Mock codes • Disaster preparedness • Equipment in place • Clinical pathways shared • Improved flow • Next Steps – • Full set of vital signs on all kids • % nurses with CEN, CPEN • Identify joint QI targets

30. Steering Committee • Kim Choppi, RN • Alan Frechette, MD • Toni Gross, MD • Anthony Huma • Kathy Karlberg, RN • Pamela Murphy, MD • Craig Norquist, MD • Kathy Northrop, RN • James Reingold, MD • Teresa Salama • Peggy Stemmler, MD • Tomi St. Mars, RN • Susan Thomas, RN • Dale Woolridge, MD

31. Improvement is a Journey “Do not judge me by my successes. Judge me by how many times I fell down and got back up again.” — Nelson Mandela 1918-2013