Access to optimal emergency care is limited for many U.S. children, and three medical groups are renewing efforts to overcome the barriers.
An updated policy statement from the AAP, the American College of Emergency Physicians and the Emergency Nurses Association outlines issues that discourage access to care and offers recommendations to improve access.
The policy, Access to Optimal Emergency Care for Children,is available at https://doi.org/10.1542/peds.2021-050787 and will be published in the May issue of Pediatrics.
Emergency departments (EDs) are the safety net for patients unable to receive care elsewhere and a critical resource during public health emergencies and disasters. Vulnerable populations suffer the most when the safety net fails.
In addition, most of the 27 million ED visits by children in the U.S. occur outside of children’s hospitals or pediatric medical centers, where pediatric expertise and supplies are limited.
Barriers to emergency care
Children and families face numerous challenges in getting optimal emergency care.
First, they may lack of awareness of resources. For example, families may not know when to visit an ED vs. an urgent care center.
Some families don’t have a primary care provider, which contributes to poor overall health and inadequate communication with medical personnel at all levels.
Other challenges include lack of access to 911 services, language barriers, difficulties with transportation and worries over potential social service or legal consequences.
Furthermore, prehospital care may be suboptimal for children, as pediatric readiness varies among care systems. Lack of comprehensive pediatric training, experience, competency assessment and ongoing quality improvement all contribute to poor care.
In underserved areas, closure of hospital EDs or decreased services disproportionately impact disadvantaged families. Additional barriers occur due to inequitable access to pediatric subspecialists, pediatric surgical specialists and mental health providers.
Financial considerations include inadequate payment for primary care, which decreases practices’ ability to provide unscheduled visits.
In addition, families with high-deductible insurance plans may avoid seeking needed care due to the cost or because of the complex and time-consuming documentation required for coverage.
Recommendations
Among the recommendations in the policy are the following:
Improve entry into emergency care
- Educate families about emergency resources in their community.
- Increase awareness of the problem of access to emergency care for children.
- Encourage efforts by health professionals to identify a medical home for every child.
- Improve 911 systems.
- Improve collaboration and connectivity among schools, child care facilities, mental health professionals, medical homes and local emergency medical systems.
Improve pediatric prehospital care
- Fund and promote the further development of emergency medical services (EMS) systems at all levels.
- Include children’s needs in all funded efforts to improve prehospital care.
- Encourage state EMS systems, local EMS agencies and hospitals to incorporate children in disaster planning.
Improve ED care for children, adolescents
- Promote improved readiness and a minimal standard for readiness in all EDs as outlined in the joint policy Pediatric Readiness in the Emergency Department.
- Encourage availability of and access to subspecialists.
- Support development of nurse practitioners and physician assistants with training and expertise in pediatric emergency care.
- Promote guidance on care of children with behavioral and emotional difficulties.
- Encourage EDs and facilities that provide urgent care for children to establish transfer agreements and protocols with facilities with higher levels of pediatric resources to promote timely access to specialty emergency care.
- Improve payment for pediatric care.
- Improve networks of care to allow patient access to specialty care and children’s hospitals. Improve transparency of coverage for emergency care and eliminate retrospective denial of payments.
