Pediatric patients are among the many populations that enter the emergency department (ED) doors looking for exceptional, trusted, and quality care. New national guidance pertaining to pediatric readiness in the emergency department has been released. This guidance comes from the American Academy of Pediatrics, the American College of Emergency Physicians, the American College of Surgeons, and the Emergency Nurses Association. The statement focuses on pediatric emergency preparedness, as well as how to provide more streamlined and specialized care.
Pediatric Readiness: A Critical Aspect of Patient Care
Research shows that 80% of emergency department visits involving pediatric patients take place in a local community hospital, not a childrens hospital. So, what does this tell us? It tells us that every emergency department should be prepared to care for children of any age.
Pediatric patients require specialized treatment approaches and rely on healthcare providers to have concrete knowledge of pediatric care and an experienced skill set. Pediatric healthcare includes pediatric-specific health conditions, pharmaceutical variations based upon age and weight, and unique challenges when assessing, diagnosing, and treating those within this population.
Over 30 million children and families utilize the ED as a central healthcare access point, reinforcing the need for precise treatment, expanded knowledge, and competent caregivers in this healthcare setting. According to the joint statement, high levels of pediatric readiness are linked to a 76% and 60% decrease in mortality risk for critically ill and injured children.
Lets discuss the major elements of pediatric readiness in the emergency department from the new guidelines and learn how to apply these recommendations to your emergency department, both clinically and administratively.
Six Elements of Pediatric Readiness
According to the joint policy statement, there are six elements of emergency department pediatric readiness. Implementation and adherence to the recommendations found within each of these elements serve as a catalyst for patient safety and exceptional care.
The six elements include:
- Administration and Coordination
- Pediatric Competencies for Clinical Staff
- Pediatric Equipment and Supplies
- Pediatric Policies, Procedures, and Protocols
- Pediatric Patient Safety Protocols
- Quality and Performance Improvement
Focusing on these areas of readiness and striving for improvement can result in decreased patient morbidity and mortality.
Recommendations for Readiness
The joint policy statement focuses on improved assessment and treatment methods, recommendations for administrators, and guidelines for clinical healthcare professionals. Each of these recommendations comes with a single goal in mind: improving pediatric care in the emergency department.
Lets review each element and how you can be more prepared for pediatric patients.
Administration and Coordination
Those in administrative roles have specific responsibilities and duties to ensure that EDs are equipped to care for pediatric patients and that those who care for these patients are knowledgeable and competent. The joint statement recommends the implementation of pediatric emergency care coordinators (PECCs) for every emergency department. PECCs should include a physician and a nurse to encourage proper staff training and facility readiness.
The role of PECCs would involve upholding and improving upon the other elements of pediatric readiness, such as training staff members on pediatric skills and information, implementing policies and procedures, ensuring appropriate pediatric equipment is available, communicating and coordinating with quality committees, striving for quality improvement interventions, and other necessary administrative tasks.
By providing pediatric emergency care coordinators and pediatric-specific care interventions, appropriate training can be established. Streamlined coordination between administrative and clinical personnel is vital to improving pediatric readiness in the emergency department.
Pediatric Competencies for Clinical Staff
Clinical staff must be prepared to provide emergency care to children and must be properly educated regarding pediatric care, as well as be equipped and trained in the necessary skills to provide such care. Examples include a proper understanding of weight-based medication administration and experience with diagnoses that are more common or severe amongst children, such as whooping cough or croup. Incorporation of multidisciplinary education is also encouraged.
The new guidance recommends baseline and periodic pediatric competency evaluations for emergency department staff that cover the wide variety of age groups within the pediatric population, as well as types of care that may be provided (triage, resuscitation, assessment, diagnostics, interventions, and follow-up). Additionally, it recommends that every emergency department have at least one board-certified emergency medicine or pediatric emergency medicine physician on staff to provide both experience and oversight of pediatric care.
Pediatric Equipment and Supplies
Age-appropriate pediatric supplies and equipment must be available to clinical staff in an organized, easily accessible location. A pediatric resuscitation cart should include specific age-based and weight-based equipment and medications to care for children ranging from neonates to adolescents. Equipment should be assessed daily to ensure that the cart is stocked, supplies are up to date, and that it is in its proper location.
Pediatric Policies, Procedures, and Protocols
As with any type of healthcare, policies, procedures, and protocols are put in place to protect patient safety and to provide guidance for clinical staff. A core characteristic of effective policies, procedures, and protocols is that they are based upon evidence-based research and information.
The joint statement supports the incorporation of evidence-based policies and protocols, as well as adopting guidelines and decision support tools, having standardized assessments, and ensuring appropriate personnel are available for patient care. Some of the guidelines included in the new recommendations pertain to protocols for treating common pediatric conditions, easily accessible poison control information, policies regarding vital sign assessments, protocols for treating pediatric patients in a disaster, and procedures for mental or behavioral health screenings and emergencies. Incorporating policies, procedures, and protocols in the emergency department can provide patients with effective, timely, and evidence-based treatment and resources.
Pediatric Patient Safety Protocols
Patient assessment and treatment should always be focused on upholding patient safety. This statement discusses the appropriate recognition of clinical deterioration through adopting triage systems to identify those at risk. It also discusses implementing practices to reduce medication errors, utilizing tools to decrease errors such as precalculated dosing guides, implementing a 2-clinician crosscheck process, and even encouraging family engagement for high-alert medications. The adoption and incorporation of these practices and tools can dramatically increase patient safety.
Quality and Performance Improvement
In order to improve the quality of care that is provided and the effectiveness of established protocols and treatment methods, it is recommended that clinical data be gathered to assess for any weaknesses or areas that require improvement. This includes assessing pediatric deaths and adverse events to improve future patient care.
Pediatric Readiness Checklist
A pediatric readiness checklist was created to help summarize these recommendations for emergency departments and to provide specific guidance pertaining to a variety of areas within emergency medicine. This checklist serves as a visual tool to understand how prepared your ED is to provide high-quality pediatric care, as well as a means of recognizing where improvement is needed. The checklist includes specific recommendations for physical and mental health encounters, as well as addressing social and community situations. The checklist is available for download here. The Pediatric Readiness Checklist for Emergency Departments can also be accessed through this link under Table 1.
Be Prepared. Be Ready.
Is your ED prepared and ready to treat the injured and sick pediatric patients that will arrive? Pediatric patients present with unique conditions and require specific treatment variations compared to adults. Treatment may change based on age, size, and disease progression, all of which play into the treatment plans and modalities that are required when caring for pediatric patients.
For more detailed descriptions of these recommendations, The Pediatric Readiness in the Emergency Department Policy Statement should be studied and applied. Every emergency department, whether it be a freestanding ED, an ED in a rural area, or an ED in a booming metropolis, should be prepared to provide emergency care for children because pediatric patients are everywhere and deserve safe, accurate, and exceptional medical attention wherever they seek treatment.
These pediatric emergency care guidelines are not passive suggestions. These recommendations can save lives. Incorporate them into your emergency department. Be prepared. Be ready.
About the Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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