The big red Emergency sign beckoned as the family sped to the hospital, their toddler struggling with seizures. When they made it to the emergency department (ED) entrance, the parents were relieved that their child finally would be in good hands.
Unfortunately, the ED was not ready for the emergency. There were delays while the staff searched for the appropriate medical equipment and drug dosing. It had been months since the physicians and nurses had treated a critically ill child. Protocols were not in place to meet the needs of pediatric patients.
An updated policy statement titled Pediatric Readiness in the Emergency Department outlines what every ED needs to avoid such scenarios. The guidance is especially important since 83% of ill and injured children are treated in community hospital EDs.
A joint effort of the AAP Committee on Pediatric Emergency Medicine and Section on Surgery, the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), the policy is available at https://doi.org/10.1542/peds.2018-2459 and will be published in the November issue of Pediatrics.
Like the 2009 version, the updated policy addresses equipment, medications, supplies and personnel, highlighting gaps in care and emphasizing the need for administrative oversight, quality improvement (QI) and evidence-based guidelines. Recommendations apply to EDs open 24/7, including free-standing facilities and critical-access hospital EDs; they do not apply to urgent care centers.
“Every emergency department should be able to meet these needs for children … these are core minimum recommendations, not high-level or cost-prohibitive resources,” said Katherine Remick, M.D., FACEP, FAEMS, FAAP, a lead author of the policy.
More than supplies, equipment
Pediatric readiness is not just about having the right equipment and supplies. It’s also about making sure the staff knows when and how to use them, and that they’re working properly, said Dr. Remick, chair of the AAP special interest group for the National Pediatric Readiness Project (NPRP) and liaison from the National Association of Emergency Medical Technicians to the AAP Committee on Pediatric Emergency Medicine.
She said having a pediatric emergency care coordinator and implementing quality control are the two most important recommendations in the guidance. Both have been directly linked with improved overall readiness. The coordinator is essential for administrative oversight of pediatric care. Having a QI process is needed “because unless you are actually monitoring the delivery of care to a specific population, in this case pediatric patients, then you cannot assess for potential gaps or fix them,” she said.
Day-to-day pediatric readiness also is the foundation for disaster preparedness, added Dr. Remick, as “there may be a large number of ill or injured children relying on a single community ED.”
Survey informs policy
In 2013, the three groups (AAP, ACEP, ENA) that drew up the original joint guidance launched the NPRP and the federal Emergency Medical Services for Children program. To get a baseline reading of pediatric readiness, NPRP asked U.S. hospital ED leaders to take an online assessment using recommendations from the 2009 policy. The response rate was 83%, reflecting over 4,000 EDs. The results, which helped inform the current policy recommendations, included the following findings:
- Half of EDs lacked a physician or nurse pediatric emergency care coordinator.
- More than half (55%) had no QI plan addressing pediatric emergency care.
- About half of hospitals lacked a disaster plan that included care needs for children.
- About a third of respondents (32%) worked in hospitals without a process to ensure weights were measured and recorded in kilograms only.
“It’s been almost 10 years now, and we recognize that there’s a lot of new evidence and information,” Dr. Remick said. “The guidance is critical to helping support those providers, both to increase awareness around what’s needed, but also for them to be able to take the guidelines to hospital administrators or ED leadership and say, ‘This is what we need to be doing.’”