Diffusion of Innovation: A Descriptive Analysis of Pediatric Preparedness in Emergency Departments

Abstract

The purpose of this study was twofold: First, to identify essential pediatric resuscitative equipment gaps in the nation’s emergency departments; second, to identify associations among and between the domains of community and health care organizational structure as they related to hospital emergency departments’ (EDs) adoption of the 2001 “Care of the Child in the Emergency Department: Guidelines for Preparedness” (Guidelines for Preparedness) published by the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP). Diffusion of Innovation (DOI) is the theoretical concept by which multiple characteristics within the domains of health care structure and community were examined. The study was conducted using extant data from the Center for Disease Control and Prevention (CDC) branch of the National Center for Health Statistics (CDC/NCHS). This descriptive study examined the relationships regarding the organizational and community characteristics of emergency departments with the adoption of the Guidelines for Preparedness. Characteristics of pediatric patient volume, pediatric subspecialty services, per capita income, urbanicity, and region were associated with the availability of pediatric emergency care essential equipment and services. Logistic regression was used to further explore variable relationships. The study identified hospital and community characteristics associated with pediatric emergency readiness and emergency medical care services essential for the care of critically ill or injured children. The study’s community variables of per capita income and metropolitan status were significant, as were the structure variables of pediatric ED volume (size), pediatric trauma service, the presence of pediatric emergency medicine, and being a pediatric hospital. The DOI concepts of complexity and interconnectedness were drivers in both the adoption of the Guidelines for Preparedness and the compliance with pediatric essential emergency equipment. This study affirms that pediatric emergency equipment availability is a problem. Pediatrics continues to be an afterthought in emergency and disaster management, and as a nation we are not prepared for pediatric emergencies or pediatric disaster care.