According to an emergency department (ED) Benchmarking Alliance survey, pediatric patients less than 18 years of age comprise over 21% of the 130 million ED visits in the United States.1 Of these, only 10% are seen in children's hospitals, leaving over 26 million pediatric patients to be seen in general EDs throughout the country. Thus, virtually every ED will evaluate and treat pediatric patients. Pediatric emergency care is much less about who will provide care to pediatric patients than what care they are providing. The majority of pediatric patients with life-threatening diseases will have their initial resuscitation in general EDs, by general emergency physicians, and by general emergency nurses. To have the greatest impact on the well being of pediatric patients in this country, where establishment of a separate pediatric ED is unpractical, efforts must be focused on improving pediatric care delivered in the general ED.
Although the development and evolution of emergency medicine as a specialty has attempted to ensure a sufficient supply of emergency physicians to meet demand, there is ample evidence that the specialty is still understaffed.2,3 Furthermore, at least 3 additional factors have made it difficult to ensure that the emergency needs of pediatric patients are met.
While emergency medicine residencies are 3 to 4 years in length, many of these residencies devote less than 3 months to rotations in pediatric emergency medicine.4
Despite the fact that board certification in pediatric emergency medicine has been in place for over 20 years, there are still less than 1500 board-certified pediatric emergency physicians in the country.5
Fifty percent of EDs care for fewer than 10 pediatric patients per day, making planning and preparation both more difficult and even more essential.6
In 2009, in an attempt to improve the quality of pediatric emergency care in EDs across the country, the American Academy of Pediatrics and the American College of Emergency Physicians issued a joint policy statement: Guidelines for Care of Children in the Emergency Department.7 These guidelines provide a structured foundation from which general EDs can elevate and standardize the care of children. The authors also recognized the critical need for a pediatric champion within the department and emphasized the need for invested medical and nursing pediatric coordinators. While that champion is ideally a physician with fellowship training in pediatric emergency medicine, it is simply not possible, strictly from a person power standpoint. In most EDs that undertake a commitment to meeting the special needs of pediatric emergency patients, the champions will be emergency physicians and nurse who have a deep and keen interest in the care of these patients. This consensus document addresses the following essential areas for EDs caring for pediatric patients:
- Guidelines for administration and coordination of the ED
- Physician, nurse, and other healthcare provider staffing
- Quality and process improvement initiatives
- Patient safety
- Pediatric specific policies and procedures
- Support services
- Equipment, supplies, and medications...