Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

Abstract

This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. CURRENT STATUS AND NEEDS ED Use and ED Crowding in the United StatesApproximately 800 000 children seek care in the emergency department (ED) each day in the United States. Additionally, it is estimated that 3.4% of US children use EDs as their source for sick care. The vast majority (92%) of these children are seen in community EDs, with a smaller percentage seen in pediatric EDs. The increase in ED utilization has saturated the capacity of EDs and emergency medical services in many communities. Increases in patient volume and decreases in resources, including fragmentation of resources and shortage of critical subspecialists, have resulted in EDs facing crowding and ambulance diversion.The need for emergency medical services outstrips the available resources on a daily basis. This mismatch is reflected by the considerable increase in the number of patients visiting EDs. In 1993, 90.3 million patients visited EDs; in 2003 that number increased to 113.9 million patients. Approximately 21% of these patients were younger than 15 years. Despite the increase in ED visits, the number of hospitals decreased by 703, the number of hospital beds decreased by 198 000, and the number of EDs decreased by 425.

Pediatric Readiness in Critical Access Hospital Emergency Departments

“…For example, New Mexico has created a Child Ready Virtual Pediatric Emergency Department Telehealth Network in order to connect pediatric patients, residing in geographically isolated regions, to the right care, at the right time, right in their community . Other model policies and procedures exist for triaging children, pediatric assessment and reassessment, managing pediatric mental health care, and handling the death of a child in the ED . National initiatives support disaster plans that address pediatric patients through the HRSA EMSC Program, the National Library of Medicine, and the Hospital Preparedness Program…”

“…[42][43][44] Other model policies and procedures exist for triaging children, pediatric assessment and reassess-ment, managing pediatric mental health care, and handling the death of a child in the ED. [45][46][47][48][49] National initiatives support disaster plans that address pediatric patients through the HRSA EMSC Program, the National Library of Medicine, and the Hospital Preparedness Program. [50][51][52][53] Implementation of individual guidelines and policies can assist a CAH in providing pediatric emergency care.…”

Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19

“…In fact, overcrowding in ED has been associated with poor hospital outcomes both in adults and children (4,5); moreover, it is a well-recognized risk factor for infectious disease spreading (6). Interdisciplinary collaborative research and education are therefore still needed to develop and implement new solutions and strategies to both prevent and manage this serious drawback (7).…”

Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

“…The lack of standardized treatment protocols and/or the lack of adoption of these treatment pathways might lead to greater variability in diagnostic evaluations and treatments of children with chief complaints such as fever and upper respiratory symptoms. This rationale is supported by previous studies showing improved health care delivery and outcomes based on adherence to treatment protocols and evidence‐based pathways . In addition, other nonclinical factors that may not have been documented in the medical record, such as parental preferences, may have influenced the ED physician's medical decision making, which could have impacted the reviewer's quality‐of‐care scores for certain conditions …”