Pediatric preparedness of US emergency departments: A 2003 survey

OBJECTIVES. Our goal was to assess the degree of pediatric preparedness of emergency departments in the United States. METHODS. A closed-response survey based on the American Academy of Pediatrics/American College of Emergency Physicians joint policy statement, Care of Children in the Emergency Department: Guidelines for Preparedness, was mailed to 5144 emergency department medical and nursing directors. A weighted preparedness score ( scale of 0-100) was calculated for each emergency department. RESULTS. A total of 1489 useable surveys ( 29%) were received, with 62% completed by emergency department medical directors. Eighty-nine percent of pediatric ( age: 0-14 years) emergency department visits occur in non-children's hospitals, 26% of visits occur in rural or remote facilities, and 75% of responding emergency departments see < 7000 children per year. The vast majority of visits ( 89%) occur in emergency department areas shared with adult patients; 6% occur in a separate pediatric emergency department. Only 6% of emergency departments had all recommended equipment and supplies. Emergency departments frequently lacked laryngeal mask airways for children ( 50%) and neonatal or infant equipment. In contrast, recommended medications were more uniformly available, as were transfer policies for medical or surgical intensive care. Fifty-two percent of emergency departments reported having a quality improvement/performance improvement plan for pediatric emergency patients, and 59% of respondents were aware of the American Academy of Pediatrics/American College of Emergency Physicians guidelines. The median pediatric-preparedness score for all emergency departments was 55. Pediatric-preparedness scores were higher for facilities with higher pediatric volume, facilities with physician and nursing coordinators for pediatrics, and facilities with respondents who reported awareness of the guidelines. CONCLUSION. Pediatric preparedness of hospital emergency departments demonstrates opportunities for improvement.