Pediatrics/policy statementJoint Policy Statement—Guidelines for Care of Children in the Emergency Department
Section snippets
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
- a
- 1
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
- 1
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
References (44)
- et al.
Critical pediatric equipment availability in Canadian hospital emergency departments
Ann Emerg Med.
(2001) - et al.
Medication safety in critically ill children
Clin Pediatr Emerg Med.
(2006) - et al.
Why culture and language matter: the clinical consequences of providing culturally and linguistically appropriate services to children in the emergency department
Clin Pediatr Emerg Med.
(2004) - et al.
The death of a child in the emergency department
Ann Emerg Med.
(2003) - et al.
Family presence in emergency medical services for children
Clin Pediatr Emerg Med.
(2006) - et al.
Emergency Medical Treatment and Labor Act: the basics and other medicolegal concerns
Pediatr Clin North Am.
(2006) - et al.
The emergency medical services for children program: accomplishments and contributions
Clin Pediatr Emerg Med.
(2006) Care of children in the emergency department: guidelines for preparedness
Pediatrics
(2001)Guidelines for preparedness of emergency departments that care for children: a call to action
Ann Emerg Med.
(2001)- et al.
National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary
Natl Health Stat Rep.
(2008)
Staffing, capacity, and ambulance diversion in emergency departments: United States 2003-2004
Adv Data
National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary
Adv Data
Availability of pediatric services and equipment in emergency departments: United States, 2002-2003
Adv Data
Institute of Medicine Report: Emergency Medical Services for Children
Ability of hospitals to care for pediatric emergency patients
Pediatr Emerg Care
Pediatric preparedness of United States emergency departments: a 2003 survey
Pediatrics
Access to optimal emergency care for children
Pediatrics
Emergency Care for Children: Growing Pains
Management of pediatric trauma
Pediatrics
Emergency Medical Services for Children Program: Implementation Manual for EMSC State Partnership Performance Measures
Appendix W: survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs
State Operations Manual
Pediatric care recommendations for freestanding urgent care centers
Pediatrics
Cited by (58)
Comparative mortality for children at one hospital in Kenya staffed with pediatric emergency medicine specialists
2020, African Journal of Emergency MedicineNational trends in mental health-related emergency department visits by children and adults, 2009–2015
2020, American Journal of Emergency MedicineA weighty matter: Obtaining and documenting pediatric weight in the emergency department
2020, American Journal of Emergency MedicinePediatric Readiness in the Emergency Department
2019, Journal of Emergency NursingCitation 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 NursingPediatric Readiness in the Emergency Department
2018, Annals of Emergency Medicine
Published simultaneously in the October issues of Pediatrics and Journal of Emergency Nursing.