Section VII: Behavioral Health Emergencies 126 Behavioral and Psychiatric Emergencies Emily R Katz, Anik Jhonsa, Eron Friedlaender, Joel A Fein, Thomas H Chun, Laura L Chapman 127 Sexual Assault: Child and Adolescent Jennifer Molnar, Megan Schluckebier O’Connell, Cynthia Mollen, Philip Scribano Section VIII: Procedures and Appendices 128 Equipment Caleb E Ward, Dewesh Agrawal 129 Procedural Sedation Jeannine Del Pizzo, Joel A Fein, Steven M Selbst 130 Procedures Theresa M Frey, Matthew R Mittiga 131 Ultrasound Jason Levy, Joanna S Cohen, Alyssa Abo, Rachel G Rempell, J Kate Deanehan 132 Biological and Chemical Terrorism Richard J Scarfone, James M Madsen, Theodore J Cieslak, Edward M Eitzen Jr 133 Instructions for Parents Hilary A Hewes, Nanette C Dudley 134 Prehospital Care Toni K Gross, Theresa A Walls, George A (Tony) Woodward 135 Technology-Assisted Children Ellen G Szydlowski, Kathleen M Cronan, Joel A Fein, Jill C Posner Index To view this chapter please access the eBook bundled with this text Please see the inside front cover for eBook access instructions SECTION I Core Principles of Quality and Safety CHAPTER ■ INTRODUCTION: HIGHQUALITY EMERGENCY CARE FOR CHILDREN KATHY N SHAW, RICHARD G BACHUR GOALS OF EMERGENCY CARE Our primary goal as practitioners is to provide high-quality, safe care for each child who arrives in our emergency department The ability to stay current with knowledge and clinical skills across all possible conditions is impossible for any clinician Furthermore, the evidence may be poor, inconsistent, or changing for the management of many diseases or injuries This leads to a wide variation in practice, high rates of inappropriate care, patient harm, and wasted resources Additionally, the model of optimal care in emergency departments is challenged by high acuity and crowding that demands teamwork, resources, a well-structured quality program, and a culture of high reliability With this new edition of the Textbook of Pediatric Emergency Medicine , we provide easy web-based access for use in practice, links to clinical pathways based on the latest evidence and expert consensus, and a new, streamlined format that emphasizes the goals of quality care KEY POINTS Standardization of care by using evidence-based clinical pathways or guidelines reduces variation in practice and decreases the rates of inappropriate care for children Easily accessed web-based resources aid clinicians in reducing medical errors due to cognition Teamwork, communication, and a nonpunitive reporting environment are key to providing safe care for children in EDs Both the systems at the “blunt end” and the practices of the clinicians at the “sharp” end must be consistently monitored and improved to provide highly reliable care Beyond evidence and expert consensus, optimal health care also requires a humanistic approach which includes compassion, collaboration with the patient and family, attention to the health care experience, and patient-reported outcomes QUALITY AND ITS MEASUREMENT IN PEDIATRIC EMERGENCY MEDICINE KEY POINTS Pediatric Quality Improvement Coordinators and Committees are essential to providing safe care for children in EDs Monitoring pediatric indicators across the six domains of quality and instituting improvement when needed are essential to providing the highest value and safest care for children in our EDs Current Evidence and Practice The quality and safety of pediatric emergency medicine vary widely In addition to unexplained variations in care related to individual providers and hospitals, there is likely a bimodal relationship between volume and quality In other words, providers in EDs where pediatric volumes are low may lack familiarity with pediatric diseases and may also lack needed experienced clinical team members, processes, basic equipment, and supplies to care for children In contrast, overcrowding in EDs with very high pediatric volumes ... MEASUREMENT IN PEDIATRIC EMERGENCY MEDICINE KEY POINTS Pediatric Quality Improvement Coordinators and Committees are essential to providing safe care for children in EDs Monitoring pediatric indicators... quality program, and a culture of high reliability With this new edition of the Textbook of Pediatric Emergency Medicine , we provide easy web-based access for use in practice, links to clinical pathways... HIGHQUALITY EMERGENCY CARE FOR CHILDREN KATHY N SHAW, RICHARD G BACHUR GOALS OF EMERGENCY CARE Our primary goal as practitioners is to provide high-quality, safe care for each child who arrives in our emergency