Abstract
BackgroundChildren account for nearly 20% of all US emergency department (ED) visits, yet previous national surveys found that many EDs lack specialized pediatric care. In response, a 2001 joint policy statement recommended resources needed by EDs for effective pediatric emergency care delivery. We sought to update and enhance previous estimates of pediatric services available in US EDs.MethodsWe administered a telephone survey to a 5% random sample (n = 279) of all US EDs from the 2007 National Emergency Department Inventory-USA. The survey collected data on local capabilities (including typical management of three clinical scenarios) and prevalence of a coordinator for pediatric emergency care. We used descriptive statistics to summarize data. Multivariable logistic regression was used to examine the association between survey respondent and ED characteristics as well as the presence of a coordinator for pediatric emergency medicine.ResultsData were collected from 238 hospitals (85% response rate). A minority of hospitals had pediatric departments (36%) or intensive care units (12%). The median annual number of ED visits by children was 3,870 (interquartile range 1,500–8,800). Ten percent of hospitals had a separate pediatric ED; only 17% had a designated pediatric emergency care coordinator. Significant positive predictors of a coordinator were an ED pediatric visit volume of ≥1 patient per hour and urban location. Most EDs treated only mild-to-moderate cases of childhood bronchiolitis and asthma exacerbation (77% and 65%, respectively). Less than half (48%) of the hospitals reported the ability to surgically manage a child with acute appendicitis.ConclusionWe found little change in pediatric emergency services compared to earlier estimates. Our study results suggest a continued need for improvements to ensure access to emergency care for children.
Highlights
Children account for nearly 20% of all US emergency department (ED) visits, yet previous national surveys found that many emergency departments (EDs) lack specialized pediatric care
In 2001, on the heels of a statement from the Institute of Medicine (IOM) revealing inadequate integration of pediatric services into the emergency health care system [8], joint policy guidelines were issued on the care of children in the ED [6]
We examined the association between presence of inpatient pediatric inpatient services and volume of pediatric ED care and found that those with inpatient pediatric care saw a median of 9,500 ED visits while those without saw a median of 2,300 ED visits (P < 0.001)
Summary
In 2001, on the heels of a statement from the Institute of Medicine (IOM) revealing inadequate integration of pediatric services into the emergency health care system [8], joint policy guidelines were issued on the care of children in the ED [6]. These guidelines (updated in 2009) are intended for all EDs that care for children, are open 24 h per day, 7 days per week, and have a physician continuously on duty. The guidelines included recommendations that EDs should: (1) appoint coordinators for the emergency care of children, (2) have age-appropriate equipment/medications/supplies, and (3)
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