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Pediatric preparedness of US emergency departments: a 2003 survey
Marianne Gausche-Hill1, Charles Schmitz, Roger J Lewis
1Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Box 21, Torrance, CA 90509, USA. mgausche@emedharbor.edu
Insights
Pediatric emergency departments show significant room for improvement in preparedness. Many facilities lack essential equipment and supplies for children, highlighting a critical need for enhanced pediatric emergency care standards across the US.
Area of Science:
- Emergency Medicine
- Pediatrics
- Healthcare Quality Improvement
Background:
- Most pediatric emergency visits occur in non-specialized children's hospitals.
- A significant portion of pediatric emergency care is delivered in rural or remote settings.
- Many emergency departments handle a low volume of pediatric patients annually.
Purpose of the Study:
- To evaluate the level of pediatric preparedness in US emergency departments.
- To identify areas needing improvement in pediatric emergency care.
- To assess adherence to established pediatric emergency care guidelines.
Main Methods:
- A national survey was distributed to emergency department directors.
- The survey was based on American Academy of Pediatrics/American College of Emergency Physicians guidelines.
- A weighted preparedness score was calculated for each facility.
Main Results:
- Only 6% of emergency departments had all recommended pediatric equipment and supplies.
- Shortages were noted in pediatric-specific airway devices and neonatal equipment.
- While medications and transfer policies were generally available, quality improvement plans and guideline awareness were inconsistent.
Conclusions:
- US emergency departments have substantial opportunities to enhance pediatric preparedness.
- Improving pediatric emergency care requires addressing equipment, supply, and planning deficiencies.
- Awareness of guidelines and dedicated pediatric coordination correlate with higher preparedness scores.
Objectives:
Our goal was to assess the degree of pediatric preparedness of emergency departments in the United States.
Methods:
A closed-response survey based on the American Academy of Pediatrics/American College of Emergency Physicians joint policy statement, "Care of Children in the Emergency Department: Guidelines for Preparedness," was mailed to 5144 emergency department medical and nursing directors. A weighted preparedness score (scale of 0-100) was calculated for each emergency department.
Results:
A total of 1489 useable surveys (29%) were received, with 62% completed by emergency department medical directors. Eighty-nine percent of pediatric (age: 0-14 years) emergency department visits occur in non-children's hospitals, 26% of visits occur in rural or remote facilities, and 75% of responding emergency departments see <7000 children per year. The vast majority of visits (89%) occur in emergency department areas shared with adult patients; 6% occur in a separate pediatric emergency department. Only 6% of emergency departments had all recommended equipment and supplies. Emergency departments frequently lacked laryngeal mask airways for children (50%) and neonatal or infant equipment. In contrast, recommended medications were more uniformly available, as were transfer policies for medical or surgical intensive care. Fifty-two percent of emergency departments reported having a quality improvement/performance improvement plan for pediatric emergency patients, and 59% of respondents were aware of the American Academy of Pediatrics/American College of Emergency Physicians guidelines. The median pediatric-preparedness score for all emergency departments was 55. Pediatric-preparedness scores were higher for facilities with higher pediatric volume, facilities with physician and nursing coordinators for pediatrics, and facilities with respondents who reported awareness of the guidelines.
Conclusion:
Pediatric preparedness of hospital emergency departments demonstrates opportunities for improvement.
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