Download PDF
J Pediatr Intensive Care 2017; 06(01): 060-065
DOI: 10.1055/s-0036-1584678
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Lessons from the Design and Implementation of a Pediatric Critical Care and Emergency Medicine Training Program in a Low Resource Country—The South American Experience

Toni Biskup
1   Department of Pediatrics, Universidad San Francisco de Quito Medical School, Cumbayá, Ecuador
2   Hospital de los Valles, Ecuador
,
Phillip Phan
3   The Johns Hopkins Carey Business School, Baltimore, Maryland, United States
4   Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
,
Michelle Grunauer
1   Department of Pediatrics, Universidad San Francisco de Quito Medical School, Cumbayá, Ecuador
2   Hospital de los Valles, Ecuador
3   The Johns Hopkins Carey Business School, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

24 June 2015

15 February 2016

Publication Date:
29 June 2016 (online)

    Permissions and Reprints

Abstract

For more than 60 years, the world has recognized the need for pediatric critical care (PCC). Today, most low- and middle-income countries (LMICs) still lack access to pediatric intensive care units (PICUs) and specialists, resulting in high rates of morbidity and mortality. These disparities result from several infrastructure and socioeconomic factors, chief among them being the lack of trained PCC and emergency medicine (PCCEM) frontline providers. In this article, we describe a continuing medical education model to increase frontline PCC capacity in Ecuador. The Laude in PCCEM is a program created by a team of Ecuadorian physicians at the University San Francisco de Quito School of Medicine. The program is aimed at providers with no formal training in PCC and who, nonetheless, care for critically ill children. The program resulted in stronger, more cohesive PICU teams with improved resuscitation times and coordination during simulation rounds. In hospitals that implemented the program, we saw decreased PICU mortality rates. Our aim is to identify the opportunities and challenges learned and to offer lessons for other countries that use similar models to cope with the lack of local resource availability.

Keywords

pediatric critical care training - low resource environment - program design - Advanced Pediatric Life Support - sustainability
 

  • References

  • 1 UNICEF. Levels and Trends in Child Mortality Report 2014. New York: The United Nations Children's Fund; 2014
    Google Scholar
  • 2 González RP. Salud Materno-Infantil en las Américas. Rev Chil Obstet Ginecol 2010; 75 (06) 411-421
    PubMedGoogle Scholar
  • 3 Duke T, Wandi F, Jonathan M. , et al. Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea. Lancet 2008; 372 (9646): 1328-1333
    CrossrefPubMedGoogle Scholar
  • 4 Baker T. Critical care in low-income countries. Trop Med Int Health 2009; 14 (02) 143-148
    CrossrefPubMedGoogle Scholar
  • 5 Murthy S, Adhikari NK. Global health care of the critically ill in low-resource settings. Ann Am Thorac Soc 2013; 10 (05) 509-513
    CrossrefPubMedGoogle Scholar
  • 6 Riviello ED, Letchford S, Achieng L, Newton MW. Critical care in resource-poor settings: lessons learned and future directions. Crit Care Med 2011; 39 (04) 860-867
    CrossrefPubMedGoogle Scholar
  • 7 American Academy of Pediatrics. Committee on Pediatric Emergency Medicine. American College of Critical Care Medicine. Society of Critical Care Medicine. Consensus report for regionalization of services for critically ill or injured children. Pediatrics 2000; 105 (11) 152-155
    CrossrefPubMedGoogle Scholar
  • 8 Molyneux E. Emergency care for children in resource-constrained countries. Trans R Soc Trop Med Hyg 2009; 103 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 9 Hoque DME, Rahman M, Billah SM. , et al. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh. BMC Pediatr 2012; 12: 197-206
    CrossrefPubMedGoogle Scholar
  • 10 Baker T. Pediatric emergency and critical care in low-income countries. Paediatr Anaesth 2009; 19 (01) 23-27
    CrossrefPubMedGoogle Scholar
  • 11 Downes JJ. The historical evolution, current status, and prospective development of pediatric critical care. Crit Care Clin 1992; 8 (01) 1-22
    CrossrefPubMedGoogle Scholar
  • 12 Lumb PD. The World Federation: enhancing global critical care practice and performance. Crit Care Clin 2006; 22 (03) 383-392 , vii
    CrossrefPubMedGoogle Scholar
  • 13 Talmor D, Shapiro N, Greenberg D, Stone PW, Neumann PJ. When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature. Crit Care Med 2006; 34 (11) 2738-2747
    CrossrefPubMedGoogle Scholar
  • 14 Profit J, Lee D, Zupancic JA. , et al. Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico. PLoS Med 2010; 7 (12) e1000379 . Doi: 10.1371/journal.pmed.1000379
    CrossrefPubMedGoogle Scholar
  • 15 Campos-Miño S, Sasbón JS, von Dessauer B. Pediatric intensive care in Latin America [in Spanish]. Med Intensiva 2012; 36 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 16 UNICEF. Ecuador Statistics. Site updated December 2013. Available at: http://www.unicef.org/infobycountry/ecuador_statistics.html . Accessed April 12, 2015
    PubMedGoogle Scholar
  • 17 Rakha MA, Abdelmoneim ANM, Farhoud S. , et al. Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt. BMJ Open 2013; 3 (01) e001852 . Doi: 10.1136/bmjopen-2012-001852
    CrossrefPubMedGoogle Scholar
  • 18 Molyneux E, Ahmad S, Robertson A. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ 2006; 84 (04) 314-319
    PubMedGoogle Scholar
  • 19 Grunauer M, Mgelea E, Fabara S, Campos Miño S, Fussell M. Abstract 636: Modified Delphi assessment of need-based learning priorities for capacity building in pediatric acute care in Ecuador: a comparison with Tanzania. Pediatr Crit Care Med 2014; 15 (04) 144 . Doi: 10.1097/01.pcc.0000449362.83140
    PubMedGoogle Scholar
  • 20 Grunauer M, Yerovi R, Fabara E, Campos Miño S. Abstract 524: Lung-heart interaction: improvement of cardiac function in a patient with acute fulminant myocarditis and progressive increases in PEEP. Pediatr Crit Care Med 2014; 15 (04) 119 . Doi: 10.1097/01.pcc.0000449250.61231.33
    PubMedGoogle Scholar
  • 21 Iza GM, Iza A, Grunauer MA, Yerovi R, Campos Miño S. Abstract 303: Pediatric brain tumors: epidemiology, postoperative intensive care treatment, and early outcomes. Hospital de Los Valles 2011–2013. Pediatr Crit Care Med 2014; 15 (04) 71-71
    PubMedGoogle Scholar
  • 22 Salazar A, Yerovi R, Grunauer M, Campos Miño S. Abstract 764: Scoliosis postoperative care: characterization, risk factors for mechanical ventilation, and complications. Pediatr Crit Care Med 2014; 15 (04) 171 . Doi: 10.1097/01.pcc.0000449490.83286.ed
    PubMedGoogle Scholar
  • 23 Kaushal R, Barker KN, Bates DW. How can information technology improve patient safety and reduce medication errors in children's health care?. Arch Pediatr Adolesc Med 2001; 155 (09) 1002-1007
    CrossrefPubMedGoogle Scholar
  • 24 Mills DM, Wu CL, Williams DC, King L, Dobson JV. High-fidelity simulation enhances pediatric residents' retention, knowledge, procedural proficiency, group resuscitation performance, and experience in pediatric resuscitation. Hosp Pediatr 2013; 3 (03) 266-275
    PubMedGoogle Scholar
  • 25 Nishisaki A, Hales R, Biagas K. , et al. A multi-institutional high-fidelity simulation “boot camp” orientation and training program for first year pediatric critical care fellows. Pediatr Crit Care Med 2009; 10 (02) 157-162
    CrossrefPubMedGoogle Scholar
  • 26 Okuda Y, Bryson EO, DeMaria Jr S. , et al. The utility of simulation in medical education: what is the evidence?. Mt Sinai J Med 2009; 76 (04) 330-343
    CrossrefPubMedGoogle Scholar
  • 27 Msemo G, Massawe A, Mmbando D. , et al. Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training. Pediatrics 2013; 131 (02) e353-e360
    CrossrefPubMedGoogle Scholar
  • 28 Livingston P, Bailey J, Ntakiyiruta G, Mukwesi C, Whynot S, Brindley P. Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership. Pan Afr Med J 2014; 17: 315 . Doi: 10.11604/pamj.2014.17.315.4211
    PubMedGoogle Scholar
  • 29 The American Academy of Pediatrics. APLS. Site updated 2012. Available at: http://www.aplsonline.com . Accessed June 1, 2015
    PubMedGoogle Scholar