System fragmentation; lack of funding, service coordination and accountability; and a limited workforce — particularly the scarcity of available specialists — are among the notable findings of the three Institute of Medicine reports released in June 2006. T he reports’ recommendations include improving hospital efficiency and patient flow; creating a coordinated, regionalized, and accountable system; increasing resources; and attending to the needs of children.
The report Emergency Care for Children: Growing Pains notes that children’s needs were largely overlooked when the emergency care system initially was developed and that the outcomes for children served in the system have trailed those for adults.
Growing Pains recognizes that children’s medical needs are impacted by their anatomical, physiological, developmental and emotional attributes and that these attributes need to be taken into account in healthcare providers’ assessment and treatment of children. (“Children,” as defined in the report, are age 18 or younger, and “infants” are under age 1.) Healthcare providers need specialized training and skills as well as access to specialized equipment and supplies. Furthermore, children’s needs should be fully integrated into all aspects of emergency care planning.
Among the problems identified:
- Unavailable Pediatric Equipment and Supplies—Although children make up 27 percent of all visits to the emergency department, only 6 percent of U.S. emergency departments have all of the supplies for handling pediatric emergencies and only about half of hospitals have at least half of these supplies.
- Lack of Written Transfer Agreements—Of the hospitals that lack the capabilities to care for pediatric patients, only half have written transfer agreements with other hospitals.
- Lack of Continuing Education in Pediatric Care — Continuing education in pediatric care is not required or is limited for many emergency care providers including pre-hospital emergency medical technicians.
- Medications Inadequately Tested for Children—Many medications prescribed to children have not been adequately tested or approved by the FDA for pediatric populations.
- Undertreated, Unstabilized Children—Many providers undertreat children in comparison to adults and do not properly stabilize seriously injured or ill children.
Among the recommendations:
- Further Developed and Defined Regionalization—Although regionalization of pediatric emergency care is required in some states, regionalization should be formalized in all states. A nationally recognized and easily understood system for categorization of emergency department pediatric capabilities should be implemented.
- Strengthened Workforce—All emergency care providers should possess a level of competency to deliver emergency care to children. Education, evidence-based guidelines and standards of care, and pediatric leadership all should help providers attain this competency.
- Family-Centered Care —Emergency providers should acknowledge and utilize the family’s presence, skills and knowledge of the child’s condition when caring for the child.
- Improved Evidence Base—Pediatric emergency care is a young field, and a national commitment to emergency care research is needed to ensure that treatments and management strategies are supported by scientific evidence.
- Increased Funding—Funding for the federal Emergency Medical Services for Children Program should be increased to $37.5 million per year for five years.