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A study of how well prepared US emergency departments are to treat children has shown that only 6% had all the equipment and supplies recommended in 2001 by the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP) and endorsed by 17 national organisations (Pediatrics 2007;120:1229-37).
The study was based on a questionnaire and follow-ups posted in 2003 to the medical directors of 5144 emergency departments; 1489 useable surveys were returned. The survey questions were weighted by an expert panel, which judged the importance of various criteria of paediatric care. The results were presented on a scale from 0 to 100 (perfect). The median score was 55.
The study is by Marianne Gausche-Hill, professor of medicine, David Geffen School of Medicine at the University of California in Los Angeles (UCLA), and director of emergency medical services and paediatric emergency medicine fellowships, Harbor-UCLA Medical Center, Los Angeles, and colleagues.
Professor Gausche-Hill told the BMJ that only 59% of the hospitals that answered the survey were aware of the guidelines, which were originally published in Pediatrics (2001;107:777-81) and the Annals of Emergency Medicine (2001;17:423-8). Another problem was that hospitals had not assigned a doctor and a nurse to tackle problems in paediatric care, as recommended in the Institute of Medicine’s report Emergency Care for Children: Growing Pains, published in 2006.
“Hospitals that were more prepared tended to be urban, to have higher volumes, to have a separate care center for paediatric patients, to have physicians and nursing coordinators for paediatrics, [and] to be aware of the AAP/ACEP guidelines,” the authors say.
Only 6% of the hospital emergency departments surveyed reported that they had all 118 recommended equipment and supplies and 22 drugs. Some departments lacked laryngeal mask airways, which may be crucial as a “rescue device” when usual ways of opening an airway, such as a mask and bag or inserting a tube into the trachea, are not successful, Professor Gausche-Hill told the BMJ. When this criterion was excluded, 8% of emergency departments met recommended criteria.
She told the BMJ that hospitals, especially those that saw few paediatric patients, were afraid of the cost of the full complement of recommended equipment and supplies. The actual cost would be only about $1000 (£500; €700), she said, although some drugs would need to be replaced when they reach their expiry date.
The surveys showed that 89% of 27 million emergency department visits by children were to general hospitals rather than children’s hospitals. Most often, children were seen in the main emergency department with adult patients. Hospitals that had a separate paediatric emergency department were more likely to see a higher volume of paediatric patients.
Almost all hospitals said that their radiology departments and laboratories could provide imaging studies of infants and children and perform necessary laboratory tests. They also said that they had a plan to transfer paediatric patients who need intensive care and that they had a policy on possible child maltreatment.