Research In Action

In a new paper from Center for Injury Research and Prevention and Center for Pediatric Traumatic Stress colleagues, we report on a tool that can help healthcare teams in the Emergency Department (ED) improve their trauma-informed and family-centered care during pediatric resuscitation.

Patient- and family-centered care (PFCC) is care that emphasizes respect for patient and family perspectives and encourages patient and family participation in care and decision-making. Trauma-informed care (TIC) refers to providing healthcare in a way that minimizes the potential for psychological traumatization or PTSD symptoms related to illness, injury, or treatment experiences. PFCC and TIC are complementary, distinct but overlapping, concepts; each is associated with improved health outcomes and better patient and family experience.

Based on the research evidence regarding the positive impact of family-centered and trauma-informed care, key professional organizations have issued strong policy statements supporting these approaches. But, as Dr. Jill M. Baren pointed out over 20 years ago, it is unfair to expect healthcare professionals to change their behavior with regard to family-centered care in the ED without providing a methodology to do so. And unfortunately there has been a gap between policy and practice – with policy rarely translated into concrete, measurable, and teachable skills and practices for healthcare providers and teams. (One notable exception comes from right here in the CHOP ED, where a teamled by Dr. Mirna Farah described specific practices for implementing family presence from the time of the family’s arrival at the ED, throughout the resuscitation event, and after resuscitation is over.)

Helping to Fill the Gap for Care

Our project aimed to help fill this gap for pediatric resuscitation care in the ED. We wanted to translate broad practice guidelines from professional organizations, as well as existing research evidence from diverse fields, to:

• define a set of core PFCC and TIC domains
• identify granular, evidence-based PFCC and TIC practices
• develop practical methods to assess these behaviors during pediatric resuscitation 

Our multidisciplinary team started by reviewing relevant policy statements, guidelines, and research to define six core domains of PFCC and TIC. We then identified observable evidence-based practices in each domain, and reviewed videos of provider/team behaviors in a wide range of simulated pediatric resuscitation scenarios to refine this list of practices. Finally, we developed and piloted an observational checklist to turn the list of behaviors into a tool that teams can use for self-assessment, quality improvement, or research. The Observation Checklist for Pediatric Resuscitation (with scoring guidelines) is freely available through the Center for Pediatric Traumatic Stress website.

We believe this project represents a key first step by providing a useful framework for training and implementation efforts to improve patient outcomes through PFCC/TIC. We hope that others will try out the tool and help to refine and improve it for other areas of pediatric care.