Pediatric Informatics: Computer Applications in Child Health (Health ...

7 Pediatric Emergency and Pediatric Critical Care Considerations 71
harm to children. Equipment that is routinely used in adult care (esophageal
obturator airways 11 (or other devices that may cause pressure necrosis) and automatic
external defibrillators 12 ) may be contraindicated in children.
7.2.3 Core Data
Personal identifiers: Accurate identification of patients is needed to link
patients to appropriate care. Their management includes handling of privacy
issues.
Real-time vital signs: The high potential for arrest with the need for immediate
response requires continuous monitoring of vital signs, at the bedside or
remotely.
Standard terminology: In addition to accurate descriptions, calculated indicators
are available to communicate physiologic status or predict outcomes
(Glasgow Coma Score, 13 Apgar Score, 14 PRISM/PIM Scores 15 ) that must be
validated and standardized for performance.
7.3 PEM and PCC: Workflow and Information
PEM and PCC are high-risk workflows of variable complexity that involve a great
breadth, depth, rate, and scope of information that must be quickly organized to
provide effective care (the range and number of problems that must be considered
and managed simultaneously, the level of physiologic and descriptive detail
that must be measured and shared, the invasiveness of diagnostic and therapeutic
modalities and the types of rapid complex clinical decisions that must be made),
in highly distractive environments. Communication and information use patterns in
PEM and neonatal ICU environments have been studied, with physician preferences
in PEM 16 and neonatal ICUs 17 for trend information (flow sheets) and direct (faceto-face)
communication with colleagues (physicians and nurses) that are different
from those in adult environments. In addition, there is need for overviews of patient
locations (whiteboards) 18 for larger emergency departments, observation units
(under 24 h) run by emergency staff 19 and for surge or disaster 20 management.
Pediatric EDs are vulnerable to medication reconciliation failures, 21 while
PICU and NICU workflows have vulnerabilities 22–24 in medication, documentation
25 and total parenteral nutrition ordering. 26 Studies in pediatric EDs 27–29 have
also shown vulnerabilities to medication delivery errors, with weight based dosing
posing a significant risk unique to pediatrics in the ED setting when compared
to a general adult ED. 30 These challenges are opportunities for improvement
that health information technology, such as CPOE, decision support, structured
documentation, results review, and enhanced communication in these high-paced
environments. 31