The optimal organization of pediatric emergency services

The care for the acutely ill and injured child has undergone marked improvements in the last two decades. In the developed world children are receiving better care in the prehospital setting and in the emergency department (ED). Current evidence suggests that effective communication, collaboration with other areas in the hospital and improved turnaround time are essential for improved outcome for the very sick child. A better understanding of the ED model and appreciation of factors contributing to its input, throughput and output informed policy makers of the reasons for overcrowding and informed solutions. Systematic triage of patients, utilization of fast-track areas within the ED, bed-side registration and nurse-initiated protocols, have all been suggested as promising tools to overcome overcrowding.