Updated Guidelines Aim for Best Pediatric Care in All EDs

Marcia Frellick

November 01, 2018

Updated guidelines entitled, "Pediatric Readiness in the Emergency Department," aim to ensure that every injured or critically ill child receives the best care possible. The guidelines — jointly developed by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association — were published online November 1 in Pediatrics.

The guidelines were published simultaneously in the Annals of Emergency Medicine and the Journal of Emergency Nursing.

The guidelines were written by Katherine Remick, MD, from the National Emergency Medical Services for Children Innovation and Improvement Center at Baylor College of Medicine in Houston, Texas, and the Department of Pediatrics at Dell Medical School at the University of Texas at Austin and the Dell Children's Medical Center in Austin, and colleagues.

Joseph Wright, MD, MPH, senior vice president and chief medical officer for University of Maryland Capital Region Health, in Cheverly, who is a coauthor of the guidelines, told Medscape Medical News, "We need to improve disaster readiness with children. Only about half of hospitals have specific care plans for children in disaster."

He noted that children have unique anatomic, physiologic, and psychological needs, adding that for too long, pediatric care has been extrapolated from adult care.

Need for Pediatric Emergency Care Coordinators

Wright said one of the most important recommendations is identifying a physician and a nurse pediatric emergency care coordinator (PECC).

According to the National Pediatric Readiness Project, a quality improvement project started in 2013, only 52.5% of emergency departments (EDs) had a physician PECC, and only 40.7% had a nurse PECC.

"[EDs] that have a PECC are strongly correlated with higher readiness scores," he said.

These guidelines benefit from that kind of data analysis, which wasn't as available in 2009, when the previous version of the guidelines was published.

In recent years, data have shown that not all children who present with head injuries need a CT scan, Wright noted. Those recommendations are part of the new guidelines, as are new evidence-based recommendations on treating children with asthma and seizures.

The National Pediatric Readiness Project also showed that the nation scored an average of 70 (on a 100-point scale) in pediatric emergency care readiness and that most children are treated in EDs that see fewer than 15 children per day.

The guidelines will help fill gaps in efficiency and proficiency that occur when few are treated daily, Wright said.

The low numbers treated daily had impeded research at individual hospitals, but the federally funded Pediatric Emergency Care Applied Research Network (PECARN) has opened up research possibilities nationwide.

"Now that we are collaborating through the country with PECARN, we are able to answer some of the very basic questions," Wright explained.

The guidelines also call for disaster drills at least once every 2 years. It is recommended that such drills include a pediatric mass casualty scenario and that written plans and agreements be established for transferring patients among pediatric facilities safely.

The authors conclude, "All EDs must be continually prepared to receive; accurately assess; and, at a minimum, stabilize and safely transfer children who are acutely ill or injured. This is necessary even for hospitals located in communities with readily accessible pediatric tertiary-care centers and regionalized systems for pediatric trauma and critical care."

According to the 2014 National Hospital Ambulatory Medical Care Survey, there were 141 million ED visits in the United States in 2014; 20% were for patients younger than 15 years. Most (up to 83%) of children needing emergency care are taken to a nonpediatric ED, according to the guidelines.

The new guidelines will provide the standard for measuring progress, Wright said.

"We will be using these guidelines as the benchmark. That's something we previously had not been able to do — execute a quality improvement program with evidence-based guidelines that we can measure ourselves against."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 1, 2018. Full text

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