Emergency Department Pediatric Emergency Care Coordinator

What is an Emergency Department Pediatric Emergency Care Coordinator?

• A physician, advanced practice provider, or nurse that works in emergency medicine and is qualified by the facility to provide emergency care
• Promotes excellence of pediatric care by all working in the emergency department
• Assist with development of pediatric components in the QI plan and facilitate QI activities related to pediatric emergency care
• Assist with development and review of ED policies and procedures, and standards for medications, equipment, and supplies
• Collaborate with EMS providers and Prehospital Pediatric Emergency Care Coordinators
• Encourage, assist and/ or facilitate pediatric emergency medical and nursing education for ED healthcare providers and staff
• Ensure pediatric patients are represented in hospital disaster/ emergency preparedness plans and include pediatric patients during disaster drills
• Communicate with ED and hospital leaders on efforts to facilitate pediatric emergency care

Readiness Improvement Plan Suggestions

The goal of a pediatric readiness improvement plan is to provide further insight and efforts to improve overall pediatric preparation and to sustain the answers on the pediatric readiness survey and/or provide a plan for improvement in the areas that the hospital seeks to improve scores in.

For example, if the hospital scored 0 in Administration and Coordination for the Care of Children in the ED, then the hospital may wish to focus on a plan on how that will be improved.

These suggestions have been developed based on the recommended resources necessary to prepare emergency departments (EDs) to care for pediatric patients.

1. Administration and Coordination for the Care of Children in the ED

1. Identification of a PECC is central to the readiness of any ED that cares for children.
   1. The PECC can be a physician, advanced practice provider, or nurse who is concurrently assigned to other roles in the ED or who oversees more than one program.
   2. The PECC needs to be qualified by the facility to provide emergency care.
   3. The roles of the PECC can include efforts to:
      1. Promote adequate skill and knowledge of all ED staff in the emergency care and resuscitation of infants and children.
      2. Assist with the development of the pediatric components of the QI plan and facilitate QI activities related to pediatric emergency care.
      3. Assist with development and periodic review of ED policies and procedures and standards for medications, equipment, and supplies to ensure adequate resources for children of all ages.
      4. Collaborate with emergency medical services (EMS), and emergency preparedness coordinators.
      5. Assist in integration of services along the pediatric care continuum, such as pediatric injury prevention, chronic disease management, and community education programs.
      6. Encourage, assist and/or facilitate pediatric emergency medical and nursing education for ED health care providers and staff.
      7. Assist in the inclusion of pediatric-specific elements in physician and nursing orientation in the ED.
      8. Assist with/facilitate, as needed, competency evaluations for staff that are pertinent to children.
      9. Facilitate integration of pediatric needs in hospital disaster/emergency preparedness plans and promote inclusion of pediatric patients in disaster drills.
      10. PECCs should collaborate with ED leadership to enable adequate staffing, medications, equipment, supplies, and other resources for children in the ED.
      11. Communicate with ED and hospital leadership on efforts to facilitate pediatric emergency care.

2. Competencies for Physicians, Advanced Practice Providers, Nurses, and Other ED Health Care Providers

1. ED health care providers, based on their level of training and scope of practice, should have the necessary skills, knowledge, and training in the emergency evaluation and treatment of children of all ages, consistent with the services provided by the hospital.
2. Baseline and periodic competency evaluations completed for all ED clinical staff determined by each institution's hospital policy and medical staff privileges as a part of the local credentialing process for all licensed ED staff.
   1. Evaluation of such competencies may be achieved through direct observation, chart reviews, practical skills demonstrations, and/or written knowledge tests.

3. Quality Improvement/Performance Improvement in the ED

1. Quality is best assured by evaluating each of the 6 domains addressed by the Institute of Medicine: safe, equitable, patient-centered, timely, efficient, and effective. Performance Improvement processes are essential to evaluating quality of care, and measurement is integral to PI activities. Pediatric-specific metrics should be carefully identified to assess the quality of care throughout each phase of health care delivery across the emergency care continuum.
   1. The QI/PI plan of the ED should include pediatric specific indicators. Pediatric emergency care metrics have been identified (see Table 1) and should be strongly considered for inclusion in the overall QI plan. In addition, performance bundles may be used to assess quality of care provided for specific clinical conditions (e.g., pediatric septic shock, pediatric asthma, pediatric closed head injury).

4. Policies, Procedures, and Protocols for the ED

1. Assist with the development, integration, and regular review of hospital pediatric interfacility transfer guidelines and agreements.
2. Assist with the development, integration, and regular review of hospital pediatric policies, procedures, and protocols around pediatric care.
   1. Policies, procedures, and protocols for the emergency care of children are age specific and include neonates, infants, children, adolescents, and children with special health care needs. Staff are educated accordingly and monitored for compliance and periodically updated. These include, but are not limited to, the following:
      1. Illness and injury triage
      2. Pediatric patient assessment and reassessment
      3. Documentation of a full set of pediatric vital signs
      4. Identification and notification of the responsible provider of abnormal vital signs (age or weight based)
      5. Immunization assessment and management (e.g., tetanus and rabies) of the under immunized patient
      6. Sedation and analgesia (including nonpharmacologic interventions for comfort) for procedures, including medical imaging
      7. Consent (including situations in which a parent or legal guardian is not immediately available)
      8. Social and behavioral health issues, including belligerent, impaired, or violent parents and patients
      9. Physical or chemical restraint of patients
      10. Child maltreatment mandated reporting and assessment (physical and sexual abuse, sexual assault, human trafficking, and neglect)
      11. Death of a child in the ED
      12. Do-not-resuscitate orders
      13. Lack of a medical home
      14. Children with special health care needs, including developmental disabilities.
      15. Family-centered care
      16. Communication with patient's medical home or primary health care provider at the time of the ED visit.
      17. Telehealth and telecommunications
      18. All-hazard disaster preparedness plans

5. Pediatric Patient and Medication Safety in the ED

The delivery of pediatric care should reflect an awareness of unique pediatric patient safety concerns and should include the following policies or practices:

1. Assist with the development, integration, and regular review of hospital pediatric patient and medication safety plans.
   1. Children should be weighed in kilograms and the weight should be recorded in a prominent place on the medical record, preferably with the vital signs.
      1. For children who require resuscitation or emergency stabilization, a standard method for estimating weight in kilograms should be used (e.g., a length-based tape).
   2. A full set of vital signs should be recorded and reassessed per hospital policy for all children.
   3. Processes for safe medication (including blood products) prescribing, delivery, and disposal should be established.
   4. Establish a culture of safety surrounding pediatric medication administration that encourages reporting of near-miss or adverse medication events that can then be analyzed to feed back into the system in a continuous QI model.
   5. Pediatric emergency services should be culturally and linguistically appropriate, and the ED should provide an environment that is safe for children and supports patient- and family-centered care.
   6. Patient-identification policies, consistent with The Joint Commission's national patient safety goals, should be implemented and monitored.
   7. Policies for the timely tracking, reporting, and evaluation of patient safety events and for the disclosure of medical errors or unanticipated outcomes should be implemented and monitored, and education and training in disclosure should be available to care providers who are assigned this responsibility.

6. Support Services for the ED

1. Assist with the development, integration, and regular review of support services for the ED and other partnering departments within the hospital, such as
   1. The radiology department having the skills and capability to provide imaging studies of children and have the equipment necessary to do so and guidelines to reduce radiation exposure that are age and size specific.
   2. The laboratory having the skills and capability to perform laboratory tests for children of all ages, including obtaining samples, and have available microtechnology for small or limited sample sizes.

7. Equipment, Supplies, and Medications

1. Consider using the "Pediatric Readiness in the ED Checklist" (rev. April 5, 2021) to ensure critical components for pediatric care.
2. Assist with the development, integration, and regular review of procedures to ensure ED staff is aware of equipment, supplies and medication location and availability
3. Medication chart, color-based coding, medical software, or other systems should be readily available to ED staff to ensure proper sizing of resuscitation equipment and proper dosing of medications based on patient weight in kilograms.
4. Resuscitation equipment and supplies should be located in the ED; trays and other items may be housed in other departments (such as the newborn nursery or central supply) with a process to ensure immediate accessibility to ED staff. A mobile or portable appropriately stocked pediatric crash cart should be available in the ED at all times.
5. ED staff are appropriately educated as to the location of all items.
6. The ED has a regular method to verify the proper location and function of equipment and expiration of medications and supplies.