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Assessing Structural Quality Elements of Pediatric Emergency Care
Lisa L Schroeder1, Elizabeth R Alpern, Shuntel M Blecher
1From the *The Children's Mercy Hospital, Kansas City, MO; †Ann and Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine, Chicago, IL; ‡Children's Hospital of Omaha, Omaha, NE; §Children's of Alabama, Birmingham, AL; ¶Children's Hospital Association, Alexandria, VA; and ∥#Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Pediatric emergency departments are better equipped and have more protocols than previously reported. Most hospitals surveyed have essential pediatric emergency equipment and procedures in place, indicating improved care standards.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Health Services Research
Background:
- Emergency departments require specialized resources for pediatric patients.
- Assessing the availability of quality performance measures is crucial for pediatric emergency care.
Purpose of the Study:
- To evaluate the availability of stakeholder-endorsed quality structure performance measures for pediatric emergency department patients.
- To assess equipment and protocol availability in pediatric emergency care settings.
Main Methods:
- A survey was administered to Child Health Corporation of America member hospitals.
- The survey queried the availability of 6 broad equipment groups and 8 protocol/procedure elements.
- Equipment and protocol availability were assessed at multiple levels of detail.
Main Results:
- 41% of hospitals reported having all 113 recommended equipment items; 77% had complete equipment in subgroups.
- Commonly missing items included adult-sized lumbar puncture needles and hypothermia thermometers.
- 100% of hospitals had age-based vital sign methods, pediatric radiation dosing standards, and pediatric coordinators; 95% used validated triage tools and had child abuse protocols.
Conclusions:
- Pediatric emergency equipment availability has improved compared to previous reports.
- Most surveyed hospitals have key protocols and procedures for pediatric emergency care.
- These findings can serve as benchmarks for optimizing pediatric emergency care.
Background And Objective:
Emergency departments must have appropriate resources and equipment available to meet the unique needs of children. We assessed the availability of stakeholder-endorsed quality structure performance measures for pediatric emergency department patients.
Methods:
A survey of Child Health Corporation of America member hospitals was conducted. Six broad equipment groups were queried: general, monitoring, respiratory, vascular access, fracture-management, and specialized pediatric trays. Equipment availability was determined at the level of the individual item, 6 broad groups, and 44 equipment subgroups. The survey queried the availability of 8 protocol/procedure elements: method to identify age-based abnormal vital signs, patient-centered care advisory council, bronchiolitis evidence-based guideline, pediatric radiation dosing standards, suspected child abuse protocols, use of validated pediatric triage tool, and presence of nurse and physician pediatric coordinators.
Results:
Fifty-two percent (22/42) of sites completed the survey. Forty-one percent reported availability of all 113 recommended equipment items. Every hospital reported complete availability of equipment in 77% of the subgroups. The most common missing items were adult-sized lumbar puncture needles, hypothermia thermometers, and various sizes of laryngeal mask airways. Regarding the protocol/procedure elements, a method to identify age-based abnormal vital signs, pediatric radiation dosing standard, and nurse and physician pediatric coordinators were present in 100%. Ninety-five percent used a validated triage tool and had suspected child abuse protocols.
Conclusions:
Presence of necessary pediatric emergency equipment is better in the surveyed hospitals than in prior reports. Most responding hospitals have important protocol/procedures in place. These data may provide benchmarks for optimal care.
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