Pediatric Care in the Nonpediatric Emergency Department: Provider Perspectives

Most pediatric emergency visits are to nonpediatric emergency departments (EDs), and little is known about provider comfort level with pediatric patients. We aimed to assess providers' comfort level caring for pediatric patients of different age groups and perceived resources and barriers to delivering evidence-based pediatric care.

We conducted an anonymous electronic survey of providers (physicians, nurse practitioners, and physician assistants) in nonpediatric EDs in an urban area who admit to a single quaternary-care children's hospital. Questions addressed provider comfort in examining, diagnosing, and treating patients across 4 age groups; access to management guidelines; resources for education; and benefits of feedback from inpatient providers. Comfort was assessed with a 5-point Likert scale, with "comfortable" being defined as a 4 or 5. The association between patient age and provider comfort was analyzed by using logistic regression with generalized estimating equations.

We surveyed 375 providers. Our response rate was 26% (14% nurse practitioners, 34% physician assistants, and 51% physicians). Of respondents, <50% report being comfortable caring for patients <3 months of age (46% examining, 38% diagnosing, 46% treating). Thirteen percent found it mostly or very easy to keep up with pediatric management guidelines (n = 12); cited barriers were time constraints, a lack of access to journals or pediatric experts, and low institutional priority due to low pediatric volume.

This study suggests that nonpediatric ED providers' comfort in caring for pediatric patients decreases with decreasing patient age. Less than half of providers report that they are comfortable managing patients <3 months old.