Pediatrics/policy statement
Joint Policy Statement—Guidelines for Care of Children in the Emergency Department

https://doi.org/10.1016/j.annemergmed.2009.08.010Get rights and content

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Abstract

Children who require emergency care have unique needs, especially when emergencies are serious or life threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. It is imperative, therefore, that all hospital EDs have the appropriate resources (medications, equipment,

Guidelines for Administration and Coordination of the ED for the Care of Children

  • A

    A physician coordinator for pediatric emergency medicine is appointed by the ED medical director.

    • 1

      The physician coordinator has the following qualifications:

      • a

        Meets the qualifications for credentialing by the hospital as a specialist in emergency medicine or pediatric emergency medicine. It is recognized that physicians in these specialties may not always be available in some communities; in these areas, the physician coordinator must meet the qualifications for credentialing by the hospital as a

Physicians, Nurses, and Other Health Care Providers Who Staff the ED

  • A

    Physicians who staff the ED have the necessary skill, knowledge, and training in the emergency evaluation and treatment of children of all ages who may be brought to the ED, consistent with the services provided by the hospital.

  • B

    Nurses and other ED health care providers have the necessary skill, knowledge, and training in providing emergency care to children of all ages who may be brought to the ED, consistent with the services offered by the hospital.

  • C

    Baseline and periodic competency evaluations

Guidelines for QI/PI in the ED

A pediatric patient care-review process is integrated into the QI/PI plan of the ED according to the following guidelines:

  • A

    Components of the process interface with out-of-hospital, ED, trauma, inpatient pediatric, pediatric critical care, and hospital-wide QI or PI activities.

  • B

    The QI/PI plan of the ED shall include pediatric-specific indicators. Minimum components of the QI/PI process should include collecting and analyzing data to discover variances, defining a plan for improvement, and

Guidelines for Improving Pediatric Patient Safety in the ED

The delivery of pediatric care should reflect an awareness of unique pediatric patient safety concerns18, 19 and should include the following policies or practices:

  • A

    Children should be weighed in kilograms, with the exception of children who require emergency stabilization, and the weight should be recorded in a prominent place on the medical record, such as with the vital signs.

  • 1

    For children who require resuscitation or emergency stabilization, a standard method for estimating weight in kilograms

Guidelines for Policies, Procedures, and Protocols for the ED

  • A

    Policies, procedures, and protocols for the emergency care of children are developed and implemented, staff should be educated accordingly, and they should be monitored for compliance and periodically updated. These resources should include, but are not limited to, the following:

    • 1

      Illness and injury triage.

    • 2

      Pediatric patient assessment and reassessment.

    • 3

      Documentation of pediatric vital signs, abnormal vital signs, and actions to be taken for abnormal vital signs.

    • 4

      Immunization assessment and

Guidelines for ED Support Services

  • A

    The radiology department should have the skills and capability to provide imaging studies of children and have the equipment necessary to do so and must have guidelines for reducing radiation exposure that are age and size specific.38

  • 1

    The radiology capability of hospitals may vary from one institution to another; however, the radiology capability of a hospital must meet the needs of the children in the community it serves.

  • 2

    A process should be established for the referral of children to

Guidelines for Equipment, Supplies, and Medications for the Care of Pediatric Patients in the ED

  • A

    Pediatric equipment, supplies, and medications should be appropriate for children of all ages and sizes and shall be easily accessible, clearly labeled, and safely and logically organized.

  • B

    Resuscitation equipment and supplies shall be located in the ED; trays and other items may be housed in other departments (such as the newborn nursery or central supply) as long as the items are immediately accessible to the ED staff. A mobile pediatric crash cart is strongly recommended.

  • C

    ED staff shall be

Summary

The 2006 Institute of Medicine report Emergency Care for Children: Growing Pains uses the word “uneven” to describe the current status of pediatric emergency care in the United States.12 Although programs such as EMSC have led toward improvement in the level of pediatric emergency readiness in many communities,43 there remains a significant opportunity for further progress nationwide. The updated guidelines offered in this policy statement are intended to serve as a resource for clinical and

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  • Cited by (58)

    • Pediatric Readiness in the Emergency Department

      2019, Journal of Emergency Nursing
      Citation Excerpt :

      A national assessment performed in 200313 demonstrated that EDs that have staff in these positions tend to be more prepared, as measured by compliance with “Guidelines for the Care of Children in the Emergency Department” published by the American College of Emergency Physicians (ACEP) and American Academy of Pediatrics (AAP) in 2001.1 In 2009 the AAP, ACEP, and the Emergency Nurses Association (ENA), with the support of the Emergency Medical Services for Children (EMSC) program, undertook a major revision of these guidelines.3,4 The 2009 joint policy statement is the subject for this policy revision.

    • What Does it Mean to be Pediatric Ready?

      2019, Journal of Emergency Nursing
    • Pediatric Readiness in the Emergency Department

      2018, Annals of Emergency Medicine
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    Published simultaneously in the October issues of Pediatrics and Journal of Emergency Nursing.

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