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The Implementation of an Extended Hours Child Life Therapy Service in a Paediatric Emergency Department
Sally J Cahill1, Tammy Young1,2, Carlie Alicastro1,2
1The Royal Children's Hospital, Melbourne: Emergency Department, Melbourne, Australia.
Insights
Child Life Therapists (CLT) in the Emergency Department (ED) significantly reduced children's distress and pain during procedures. This integrated service improved clinical efficiency and patient care, with positive feedback from all stakeholders.
Area of Science:
- Pediatric Healthcare
- Emergency Medicine
- Child Psychology
Background:
- Child Life Therapists (CLT) support hospitalized children, but their utility in high-procedure Emergency Departments (ED) is under-researched.
- The Royal Children's Hospital (RCH) implemented an extended-hours CLT service in its ED in 2024.
Purpose of the Study:
- To outline patient demographics and CLT interventions in the RCH ED.
- To evaluate the effectiveness of CLT from the perspectives of children, caregivers, and clinicians.
- To assess the impact of CLT on procedural experience and clinical workflow.
Main Methods:
- A 6-month retrospective chart review of CLT referrals, detailing patient characteristics and interventions.
- Prospective surveys of caregivers, patients, and clinicians to gather feedback on CLT effectiveness, satisfaction, and Net Promoter Scores.
- Hospital ethics approval was obtained.
Main Results:
- CLT supported 1130 patients, with a median age of 5 years; 17% were neurodiverse.
- 66% of patients were admitted, and two-thirds required procedural support, primarily for venipuncture and finger pricks (64.4%).
- Feedback indicated reduced distress, worry, and pain for children, with clinicians reporting increased efficiency and decreased sedation/restraint use.
Conclusions:
- Child Life Therapy integration in the ED enhances patient care and optimizes clinical workflow.
- Stakeholder feedback confirms CLT's role in alleviating pediatric procedural distress, pain, and worry.
- CLT may reduce the necessity for sedation and restraint in pediatric emergency care.
Objective:
Child Life Therapists (CLT) are healthcare professionals who support children in hospital by engaging, educating and empowering them. With a high rate of procedures, the Emergency Department (ED) would seem an ideal site for CLT; however literature is limited regarding their utility. In 2024, the ED of The Royal Children's Hospital (RCH), Melbourne commenced an integrated, extended hours CLT service. This study outlines the patient demographics, support provided by CLT and presents feedback on the effectiveness of CLT from caregivers, children and clinicians.
Methods:
A retrospective chart review in 2024 included all CLT referrals over 6 months, describing patient characteristics, CLT interventions and reported CLT effectiveness. Prospective surveys of a convenience sample of carers, children and clinicians determined the effect of CLT on the procedure, net promoter scores and satisfaction scores. Hospital ethics approval was obtained (Reference number: 3915).
Results:
CLT assisted 1130 patients. Median age was 5 years (IQR 3-8 years). Seventeen percent were neurodiverse or had developmental delays. Sixty-six percent were admitted to hospital. Two-thirds required support for procedures-mainly blood tests via venepuncture and finger pricks (64.4%). One hundred and eighty-five caregivers, 58 patients and 58 clinicians responded: feedback indicated that CLT eased procedures, reduced distress, worry and pain. Clinicians reported increased procedural speed and efficiency and reduced use of sedation and restraint.
Conclusion:
Child Life Therapy enhances patient care whilst improving clinical workflow. Stakeholders indicate that CLT reduces distress, pain and worry for children and may reduce the need for sedation and restraint.
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