A Q&A with a hospital-based PECC: “It's an investment that will pay off”

Last month, registration opened for the Pediatric Emergency Care Coordinator (PECC) Workforce Development Collaborative, which launches in September. Led by the Emergency Medical Services for Children (EMSC) Innovation and Improvement Center, the collaborative aims to develop healthcare professionals in emergency settings into effective pediatric champions, or PECCs.

In this two-part Q&A series, we will explore what it means to be a PECC in hospital and prehospital settings. We begin with Steve “Jason” Crellin, DO, MBA, a pediatric emergency medicine physician at Geisinger Medical Center, located in rural central Pennsylvania. Dr. Crellin also is an EMSC Fellow and father of six.

Q: How did you get started as a pediatric champion at your hospital?

A: Conceptually, the idea of a pediatric champion existed when I was first hired, but the formal definition and titles didn’t. I ended up in that role because I was the first PEM [pediatric emergency medicine] physician hired in our health system to work full-time in the emergency department. My role within the health system positioned me to assess opportunities for improvement, to help initiate related changes, and to advocate for our pediatric patients. The direct patient care and systems-related elements of this position have always been of interest for me and something that I wanted to be involved with early in my career.

Q: What kind of support or guidance did you rely on to start?

A: I’ve received a lot of support from many residency/fellowship mentors and from my current physician and nursing work colleagues. My coworkers have been very flexible and supportive of program development and proposed system changes. Most of all, I have been blessed to have a good partner, Dr. Sarah Alander, who joined the group and has been able to help us take everything to the next level. The most valuable guidance that I’ve received is that improving pediatric readiness is a long-term process that is more like a marathon than a sprint. We are continuously taking small steps to improve our culture of pediatric readiness.

Q: When you started, were you aware of EMSC and its resources?

A: I was not—until my partner joined our group and we were discussing how we were going to build a PEM program throughout our health system. She brought up the pediatric readiness assessment and the EMSC program. The EMSC pediatric readiness assessment has really become the backbone that we've been using to assess and initiate a lot of the changes that we have made on a system level. It gives us the tools to assess our pediatric readiness and to go back to leaders in the hospital and the emergency departments and say, “This is what the recommendations are and this is what we need to be able to provide quality care for kids. These are some opportunities for improvement that we've identified. How can we get there together?’

Currently, we use the pediatric readiness assessment elements on a continuous basis. In fact, we refer back to the assessment every month through an internal EMSC Council that we’ve created with PECC [pediatric emergency care coordinator] physicians and nurses from all of our hospitals. During our internal EMSC Council, we essentially walk through all of the sections in the assessment, discussing and coordinating pediatric-related items with staffing, physician/nurse competencies, QI/PI, policies/procedures/protocols, equipment, and safety. Bringing everyone together at once allows us to discover and address pediatric-related improvement opportunities collectively, in a more organized and standardized fashion.

Q: What is your biggest challenge when it comes to trying to drive pediatric readiness?

A: The biggest challenge is resources, and I think that's probably the biggest challenge everywhere. More specifically, personnel, time, and financial constraints are a few of the biggest obstacles. COVID has not helped with the resource strain at all. How much of these resources are needed will depend on the scale of the hospital or health system, but protected time for physicians/nurses and administrative support have been particularly challenging for us. My partner and I started out doing a lot of administrative and system-building tasks over our nine-hospital system in our “extra time” while carrying a full clinical load. Fortunately, with building and demonstrating value in the program, we have recently been able to get some help.

Q: Have you tracked your outcomes or how do you make the case for a program like this?

A: In terms of making a business case, the pediatric readiness assessment has provided us with a great tool because there are published data describing pediatric mortality decreases that are associated with improving pediatric readiness scores. The pediatric readiness score and mortality data can serve both as a starting point for initiating changes and as a measure for showing improvements to leadership.

Something else that's been helpful with making the case for and measuring pediatric readiness is participation with the ImPACTS Simulation Collaborative. Through regular simulation visits to all of our hospital sites, we have been able to partner with the PECCs within each individual emergency department throughout our system to identify and address pediatric emergency education, department processes, and larger-scale systems issues identified during the simulation sessions. Making serial visits to each hospital site has also allowed us to demonstrate sustained patient care improvements to leadership through improved simulation scores.

A third area that has been helpful for tracking outcomes and showing improvement comes from patient care pathway development with EHR [electronic health record] integration and building related reporting dashboards for specific patient populations like asthmatics and pediatric sepsis patients. Through pathway development and tracking those dashboards, we have been able to show improvements with our resuscitation times and resuscitation quality both locally and throughout the system. This quality data is also shared with leadership and is used to help make the case for further program development.

Q: Can you give an example of a time you felt your work had helped directly improve care?

A: I had one shift that I walked into with a really sick trauma patient. I left the trauma bay and went out and sat down at my desk. Somebody grabbed me and they said, “We have a really sick kid that we need you to see now.” The child had a volvulus with perforation and was in septic shock. He hadn’t been in the department for very long when I walked into the room. Upon entering the room, the nurse and resident said, “We have two IVs. We have checked blood sugar. We are giving push-pull bolus IV fluids. We've given antibiotics. We're talking to the pediatric surgery service.” It was amazing. The child had been perfectly resuscitated and prepared for the OR unbelievably fast.

That is one specific example, but I see spectacular resuscitations more and more often from all of our hospitals. Celebrating these successes with my physician and nursing colleagues is one of the most gratifying things in my career. We are all making pediatric care better for our patients, their families, and for ourselves.

Q: What would you say to ED-based healthcare professionals who are interested in pediatrics, but aren’t sure if they should become a PECC?

A: Becoming a PECC is an investment that will pay off for your department and health system. The time that you dedicate to advocating and preparing for children will undoubtedly make a huge difference for pediatric patients and for everyone in your system that cares for them.

Next month’s issue will feature a Q&A with a PECC working in a prehospital setting. There are four tracks in the PECC Workforce Development Collaborative:

• EMS practitioners
• ED/hospital-based nurses or healthcare professionals
• ED/hospital-based physicians or advanced practice providers
• EMSC State Partnership program managers

Registration ends August 1, and the collaborative begins in September. Learn more or register here.