PECARN STELAR Podcast – Episode 3: PEM Disparities

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research.

This podcast on health equity and the impact of standardized clinical care pathways and decision support tools embedded in the electronic health record (EHR). In this podcast, Dr. Ilene Claudius Director of Quality Improvement in the Department of Emergency Medicine at Harbor UCLA sits down with Dr. Russ Migita from the Division of Emergency Medicine at Seattle Children’s Hospital, the nodal coordinating site for the PECARN STELAR node to talk about how Seattle Children’s has addressed health disparities through standardized clinical care pathways.

This podcast is a collaboration between PECARN STELAR node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC).

PEM Disparities

Show notes by: Mohsen Saidinejad, MD, MS, MBA, on behalf of the PECARN STELAR Node

All families deserve a fair opportunity to be as healthy as possible. Disparities are measured differences in outcomes for people of different backgrounds. Literature shows disparity across the different outcomes, including wait times, triage levels and delivery of pain medications. Dr. Migita noted differences in admission rates for asthma and bronchiolitis based on race.

This is difficult but amenable to quality assessment and improvement on both a systems and individual level using the following tools:

• Break down outcomes based on different races and backgrounds to get clear data on the hospital, department and individual providers and share this data with stakeholders and individuals
• Harvard implicit association test is an internet available test, requiring about 10 minutes, that can help people see their own unconscious biases. This is an important first step, but not enough unless combined with additional efforts.
• Discuss as often as possible. For example, incorporate equity into safety briefing
• Acknowledge that individuals are more prone to unconscious bias when operating quickly
• Add equity pause to clinical pathways (additional information on disparities and evidence embedded within clinical decision guidelines)

Pathways have streamlined:

• Triage levels
• Care delivery
• Admission rates

Seattlechildrens.org -> health care professionals -> algorithms: Information for health care professionals will have links to evidence based recommendations and pathways