Few ERs Are Equipped to Care for Children

As the flu season nears, hospital emergency departments are bracing for a fresh onslaught of patients. But research shows that the majority of EDs lack the special equipment, supplies, and expertise needed to treat children.

Out of almost 4,000 EDs in the U.S., only 6 percent are fully prepared to properly care for pediatric patients, according to a new joint policy statement from the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), published today in the journal Pediatrics.

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Experts said the guidelines for pediatric ED preparedness in the joint policy statement, which updates the 2006 guidelines from the Institute of Medicine (IOM), will spotlight the need for better pediatric care in hospitals and provide a tool to help lagging EDs get on par with their better-prepared counterparts.

"The original [2006] guidelines had 162 items in it, including various sizes of [equipment]," said Dr. Marianne Gausche-Hill, a professor of medicine at the David Geffen School of Medicine at the University of California at Los Angeles and one of the lead authors of the joint statement.

"Of all these items, only 6 percent [of EDs] had all these items," she said. "On the flip side, around 80 percent have about 90 percent of the equipment... but there are surprising deficiencies, and I think smaller hospitals need help getting these resources."

Children Require Different Equipment, Expertise

Treating children can require a variety of specialized equipment -- smaller blood pressure cuffs or narrower tubing, for example. Radiation and medication dosages need to be adjusted for children. Rectal thermometers should be available for infants.

"People think that pediatric patients are just small adults and they can [treat them] without special equipment or skill sets when, in fact, they need specialized care," said Dr. Michael Kim, head of the Pediatric Emergency Department at the American Family Children's Hospital in Madison, Wis. "If you don't have a champion in the department, these things can get overlooked."

Training Trumps Equipment in Many Cases

According to 2006 data from the IOM, children accounted for 20 percent of the 119 million ED visits.

Still, there are several reasons a hospital may not invest in a full complement of pediatric equipment. Small or rural hospitals may not see enough pediatric patients to recognize a need for special treatment. A lack of funding and space could result in neglected pediatric emergency facilities. Pediatric patients are not always in need of critical emergency care that requires special equipment.

And according to the joint statement, only 56 percent of emergency care directors were aware that guidelines for pediatric emergency care were available.

But doctors point out that training is just as important, if not more so, than facilities for a pediatric ED.

"The level of expertise among providers, even more than the equipment available, represents a major barrier to optimal care delivery," said Dr. David Cornfield, chief of pulmonary, allergy, and immunology at Lucille Packard Children's Hospital in Palo Alto, Calif.

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