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.