Patient Flow E-Newsletter
Volume 4, Issue 2
May/June 2007
Special Focus Issue-Putting Kids First

Innovations
Educational Toolkit for Pediatric Emergency Preparedness

In 2001, the American College of Emergency Physicians (ACEP) and the American Academy of Pediatrics (AAP) published guidelines on pediatric emergency preparedness for hospital emergency departments (EDs), detailing the equipment, staff and policies required to ensure the safest and highest-quality care. The guidelines seek to ensure that "all hospitals that serve as pediatric receiving facilities for emergency care, no matter their size, pediatric volume or inpatient services, be prepared to handle the pediatric patient who may enter their doors." To help hospitals implement the guidelines, the AAP and ACEP developed a toolkit on pediatric emergency care--one of the few resources available to help community hospitals prepare to care for seriously injured or sick children and adolescents.

"Hospitals are well aware of the need to address pediatric emergencies," says Marianne Gausche-Hill, M.D., a pediatric emergency medicine specialist at the Harbor-UCLA Medical Center and one of the creators of the implementation toolkit. "They are trying to figure out how to apply the recommendations on a local level."

The toolkit, Care of Children in the Emergency Department: Guidelines for Preparedness is based in a joint AAP and ACEP policy of the same name published in Pediatrics and Annals of Emergency Medicine in 2001.

The toolkit provides guidelines for improving pediatric emergency care and actionable strategies to help hospitals move toward implementation and it includes:

• Guidelines for preparedness to care for children in the emergency department
• Sample policies for the care of children in the emergency department
• Clinical care guidelines ranging from triage methods to protocols for suspected sexual abuse
• Policy statements including:
  • Access to pediatric emergency medical care
  • Appropriate inter-hospital patient transfer
  • Consent for medical services
  • Death of a child in the ED
  • Equipment for ambulances
  • Treatment considerations for children with special needs
• Referenced journal articles highlighting the clinical evidence behind the suggested policies
• Pediatric resuscitation guidelines and an emergency medication calculator
• Checklists for EDs to evaluate their preparedness to treat pediatric patients

"Since pediatrics are a fairly small portion of encounters in the ED, the purpose [of the toolkit] is to get hospitals to hone down on what is most important for treating pediatric patients, such as proper training of staff and proper equipment," says Gausche-Hill. "It is intended to be one-stop shopping for pediatric preparedness."

Gausche-Hill is leading an evaluation to determine whether the toolkit can, in fact, help hospitals meet the AAP/ACEP guidelines. The study--involving 10 community hospitals that have been using the resource and 10 control hospitals--will measure adherence with the guidelines, whether the toolkit aided self efficacy (i.e. confidence in caring for children of different ages) of the ED staff, and clinical quality. These data will be benchmarked against performance scores from four top-performing hospitals in pediatric emergency care that piloted the toolkit. The study will also include a focused evaluation involving 100 hospitals that seeks to identify the barriers to adoption of the emergency care guidelines.

Assigning a current staff member to oversee pediatric emergency preparedness and care is a crucial first step toward meeting the guidelines. The recent Institute of Medicine report on the Future of Emergency Care: Emergency Care for Children outlines recommendations for improving pediatric emergency care including: "EMS agencies should appoint a pediatric emergency coordinator and hospitals should appoint two pediatric emergency coordinators - one a physician - to provide pediatric leadership for the organization". Eventually, Gausche-Hill says, she would like to see pediatric emergency preparedness part of the hospital accreditation process.

Resources:
Institute of Medicine. Committee of the Future of Emergency Care in the U.S. Health System. Emergency Care for Children: Growing Pains. Washington, DC: National Academy Press, 2006.

American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and American College of Emergency Physicians, Pediatric Committee. Care of Children in the Emergency Department: Guidelines for Preparedness. Pediatrics 2001;107:777-781.

American College of Emergency Physicians, American Academy of Pediatrics. Care of children in the emergency department: guidelines for preparedness. Ann Emerg Med 2001 Apr;37(4):423-7.

Gausche-Hill M, Wiebe R: Guidelines for Preparedness of Emergency Departments that Care for Children: A Call to Action. Ann Emerg Med 2001;37(4):389-391.

ACEP Site - Frequently Asked Questions about Pediatric Emergency Care

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Marianne Gausche-Hill, MD
Director of Pediatric Emergency Medicine
Little Company of Mary Hospital
Clinical Professor of Medicine
UCLA School of Medicine
Harbor-UCLA Medical Center
Department of Emergency Medicine
Torrance, California