Few U.S. emergency rooms are properly equipped for children

Dec 4 2007

In the first survey to specifically measure hospital pediatric preparedness, a team of Los Angeles Biomedical Research Institute (LA BioMed) researchers found few U.S. emergency rooms are properly equipped for children.

The survey by Drs. Marianne Gausche-Hill, Charles Schmitz and Roger J. Lewis was reported in the December issue of Pediatrics, the peer-reviewed journal of the American Academy of Pediatrics. The team of LA BioMed researchers found only 6 percent of the 1,489 emergency rooms that responded to the survey had all the medicine and equipment the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP) recommend.

For instance, half of those responding reported that they were missing the laryngeal mask airways used for ventilating children.

“Seventeen percent of the hospitals that responded to the survey did not have Magill forceps for removing foreign bodies from a child's airway,” said Dr. Gausche-Hill. “This equipment may be life-saving, so this study highlights important issues for patient safety.”

The study found 89% of pediatric (ages: 0–14 years) emergency department visits occur in non–children's hospitals. About a fourth of these visits take place in rural or remote facilities. Only 6% occur in a separate pediatric emergency department.

More than half the emergency departments reported they had a quality improvement or performance improvement plan for pediatric patients, and 59 percent said they were aware of the American Academy of Pediatrics/American College of Emergency Physicians guidelines.

“Hospitals that were more prepared tended to be urban, to have higher volumes, to have a separate care area for pediatric patients, to have physician and nursing coordinators for pediatrics, to be aware of the AAP/ACEP guidelines, and to be interested in guideline implementation,” the researchers concluded. “The study also demonstrates that much work is left to be done to improve pediatric preparedness of (Emergency Departments) EDs. Additional work should explore the relationship of preparedness to quality of care delivered, delineate barriers to guideline implementation, and identify best practices that can be coordinated within emergency care systems to improve the preparedness of EDs to care for children.