OPERATIONS MANAGEMENT COMMITTEE
Pediatric Emergency Department Operations: Are We Pediatric Ready? Virteeka Sinha, MD, Akiva Dym, MD, Anthony Rosania, MD MHA FAAEM
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hildren have unique physical, psycho-social, and medical needs that differ from adults when seeking care in the emergency department (ED). In the National Hospital Ambulatory Medical Care data from 2014, approximately 20% of ED visits were for children younger than 15 years old.1 Children have unique challenges associated with ED visits and it is imperative that EDs are ready to address these problems. Having an ED ready to take care of an adult patient does not necessarily make it prepared to provide care for a child. In 2018, the American Academy of Pediatrics (AAP) published guidelines to ensure pediatric readiness in emergency departments.1 In their policy statement, specific steps and resources for pediatric readiness were published. Despite the recognition of the numerous unique challenges facing pediatric operations, there are few resources which exist within national and international organizations that address this topic or specifically target those issues. While there is a robust focus on clinical management of children, attention to the specific operational needs is lacking. In review of the published literature, ED operations articles that address specific pediatric operations are few and far between. One of the most significant operational challenges that pediatric EDs face is the difference and variability in pharmaceutical dosing as well as stocking of pediatric supplies. In contrast to adult EDs where stocking a medication at a standard dose or having a standard size for
equipment supplies is sufficient, pediatric EDs require meticulous preparation to stock and sample age and weight specific supplies. As a result, this resource requirement involves more personnel and resource allocation. Inadequately addressing this need poses a risk for having an inadequate supply or age-inappropriate items, leading to an increased risks for errors, confusion, provider frustration, and increased personnel use. Furthermore, ED pharmacists, stock personnel, and technicians are not always available, and pediatric care can be challenging enough without the delays associated with obtaining appropriately sized equipment or pediatric dosed medication. At this time, there are no minimal requirements set by pediatric organizations or even the local departments for the staffing of ED personnel in pediatric ED. As compared to the adult population, the care of children in a pediatric ED is resource heavy with regards to personnel use. The AAP has recommended a dyad management model, combining both physician coordinators and nursing coordinators to effectively manage a pediatric ED.1 However, most pediatric EDs are not staffed with either of these roles, let alone both. Operational committees should consider this when planning adequate staffing or mobilizing resources for pediatric care. Among the operational challenges seen in pediatrics, none may be more ubiquitous than the management of parents. Parents of children are often themselves in significant distress, even when their child is not at serious risk,
and most EDs are inadequately prepared to address the distressed parent. Previous studies have shown that parent presence during pediatric resuscitations and complex medical care could greatly reduce risk of negative outcomes.2 However, most EDs poorly accommodate these needs due to shortage of space, staff, personnel, or even child-life resources. Increasing awareness of this specific need and including this in pediatric operational discussions and planning can improve the overall flow and outcomes in the ED, as well as both parent and patient experience. In addition to the unique medical challenges posed by pediatric patients, there are numerous other factors such as anxiety, inconsolability, stranger anxiety, previous adverse effects, and the foreign ED setting which can make pediatric patients even more difficult to manage. Factors such as experienced staff, adequate staffing numbers, and a calm and supportive environment can help greatly reduce the adverse psychological effects that children may experience while in the ED.
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HAVING AN ED READY TO TAKE CARE OF AN ADULT PATIENT DOES NOT NECESSARILY MAKE IT PREPARED TO PROVIDE CARE FOR A CHILD.”
COMMON SENSE SEPTEMBER/OCTOBER 2022
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