Pediatric Emergency Readiness Improving in Hospitals

Half of the nation's emergency departments have a physician or nurse dedicated to the role of pediatric emergency care coordinator—a three-fold increase since 2003, research shows. But only half have a disaster plan that addresses issues specific to the care of children.

Children have different medical needs than adults, and that's also true in emergency situations. That's why Marianne Gausche-Hill, MD, FACEP, FAAP, of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, says it's "really heartening" that the nation's emergency departments have significantly improved their pediatric readiness in the past several years.

Gausche-Hill is the author of a study published in JAMA Pediatrics this month, which assessed how well EDs are complying with recommendations for pediatric readiness that were issued in 2009 by the American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association.

Among the resources EDs should have, according to the "Guidelines for Care of Children in the Emergency Department" are:

• A physician/nursing coordinator for pediatric emergency medicine
• Physicians and nurses who are regularly trained in emergency care for children
• A pediatric care review process that's integrated into the hospital's quality improvement plan
• The right kind of equipment to care for children

The Physician/nursing Coordinator
One of the key factors for pediatric readiness is the role of the pediatric emergency care coordinator, who ensures that staff are appropriately trained, that the ED is prepared with the right equipment, and that the right kinds of policies are in place for caring for children.

This person also looks at data and develops quality indicators to follow; liaisons with others who could have an impact on the care of children, such as the trauma committee, local EMS, or other hospitals within a system; and coordinates regular education updates for nurses.

The study found that half of the nation's EDs currently have a physician or nurse dedicated to this role, which is a three-fold increase since 2003.

Gausche-Hill says the role of the pediatric emergency care coordinator is particularly important because hospitals often don't see enough ill or injured children to realize what policies or equipment they don't have.

"The average number of children that are seen in emergency departments across the country [is fewer than] 13 a day," she says, and most of those children are actually not really very sick or hurt. "The likelihood that it's on somebody's radar on a daily basis is relatively low."

That's why the presence of a pediatric emergency care coordinator, all by itself, is important to pediatric readiness for the entire ED.

"The emergency departments that assign that role are more likely to be compliant with the guidelines," Gausche-Hill says, sometimes as much as four times as compliant. For instance, EDs with a pediatric emergency care coordinator are four times as likely to have a QI plan and twice as likely to have all the policies in place.

There were other bright spots in the assessment, such as the finding that emergency departments have 91% of recommended pediatric equipment readily available.

Room for Improvement
But there are still areas where EDs can improve. For instance, one third of EDs still weigh children in pounds, instead of kilos as is recommended, which can lead to medication dosing errors. In addition, only 47% of respondents had a disaster plan that addresses issues specific to the care of children.

The assessment also found that nearly 81% of respondents reported barriers to complying with the guidelines, such as the cost of training personnel (54%) and lack of educational resources (49%).

But Gausche-Hill says there are lots of ways around those perceived barriers, such as the wide availability of online education and sample policies. She also points to strategies such as shared equipment between low-volume and high-volume hospitals, as well as shared policies, and even shared coordinators between small hospitals.

Building awareness that pediatric readiness is important is also part of the battle, and simply completing the assessment actually helped raise awareness, Gausche-Hill says. The assessment had an 83% response rate, with 4,149 emergency departments taking it, compared with 29% in 2003.

"We are educating as well as assessing," Gausche-Hill says, adding that everyone in the study received a "Pediatric Readiness Score" and a gap analysis report. "This assessment is going to, I hope, stimulate more emergency departments to assign that role."

Gausche-Hill also says that healthcare executives can play a key leadership role in in ensuring pediatric readiness.

"I think they can take a significant role in the development of policies," she says. "When healthcare executives get excited about readiness, it really makes a significant difference."