Implementation of recommendations for the care of children in UK emergency departments: national postal questionnaire survey
1 Department of Paediatric Accident and Emergency, St Mary's Hospital, London W2 1NY
Introduction
In June 1999 an intercollegiate working party of Royal College of Paediatrics and Child Health, British Association of Accident and Emergency Medicine (BAEM), British Association of Paediatric Surgeons, Faculty of Accident and Emergency Medicine, Royal College of Nursing (RCN), and Royal College of General Practitioners was established. Terms of reference were to review emergency services for children and to make recommendations for future provision of these services. The subsequent report—Accident and Emergency Services for Children (AESC)—made 32 recommendations (representing minimum levels of care), to be implemented by 2004.1
, http://www.100md.com
Participants, methods, and results
We sent questionnaires to lead emergency doctors (listed in the BAEM's directory of 2001-2) between Oct 2003 and Jan 2004 about the recommendations. Nonresponders were re-sent the questionnaire.
Of 219 departments with inpatient paediatric facilities,2 139 (63%) replied (table). In all, 47 (34%) of replying hospitals saw more than 18 000 children annually; 41 (87%) were district general hospitals. Only 64 (29%) departments with separate paediatric emergency facilities responded; the 71% that did not respond accounted for 47% of nonresponders, many seeing more than 18 000 children annually.
, http://www.100md.com
Facilities, function, and staffing of 139 UK paediatric emergency departments
Although currently 41 departments have separate paediatric emergency departments, 92% of children attend general departments; these show the largest differences from recommendations of the AESC report. In 1997, 10% of hospitals did not have inpatient services onsite3 now only 1.9% do not (minor injury units excluded).
Wards are safe for only the initial reception of emergency admissions if appropriately equipped and staffed for reception, triage, and resuscitation1; these criteria are often not met.
, http://www.100md.com
Assessing the severity of illness is essential, but a quarter of departments seeing more than 18 000 children a year do not have separate triage facilities, and 23% do not triage children with an appropriately trained nurse. Although the pain assessment tool and the national triage score are used widely, their effectiveness must be questioned where non-trained staff are triaging. Level 2 care, while awaiting a paediatric retrieval team (children's mobile intensive care unit), is delivered in 85% of departments, often at cost to emergency, paediatric, and intensive care services. The current trend of centralisation means that emergency staff must deliver this care, so there must be the appropriate mix of skills on duty.
, 百拇医药
In 1996, 30% of hospitals did not cater for children within major incident plans (required by the National Service Framework for children and young people)4 5; fewer now have children in their plans.
The National Service Framework expects emergency professionals to do courses in paediatric life support and to regularly update; currently, 47% of nurses do not attend such courses.
Comment
One in four patients presenting at emergency departments is a child. Child centred good quality care which is accessible at the right time is required, however there is considerable room for improvement in the care of children in emergency departments. This government has recognised unacceptable variations nationwide in the quality of care for children and wants to eliminate these differences (the National Service Framework).4 5 The framework allows adult nurses to care for children only within the limits of their knowledge and should be under direct supervision of a children's trained nurse. Recruitment and retention of nursing staff is a problem in emergency departments. The Royal College of Nursing recommends rotational posts with community nursing and paediatric wards. The number of applicants for training in children's nursing exceeds the number available, so structured investment in nurse training may provide the necessary skilled nurses.
, http://www.100md.com
What is already known on this topic
Paediatric emergency services were under resourced in the United Kingdom, a report in 1999 found; the report made recommendations for improvement
What this study adds
Current emergency services for children in the United Kingdom still fall short of these essential recommendations
The AESC recommends that hospitals seeing more than 18 000 children should have a consultant in paediatric emergency medicine by 2004 and in all emergency departments by 2010. This, along with many of the other AESC recommendations made five years ago, has not been met and without future investment in staffing and facilities a child centred service will be hard to achieve.
, 百拇医药
This article was posted on bmj.com on 3 December 2004: http://bmj.com/cgi/doi/10.1136/bmj.38313.580324.F7
The questionnaire is on bmj.com
Contributors: RS was the primary investigator. IKM was supervisor. IKM is guarantor.
Funding: St Mary's Hospital NHS Trust, department of Paediatric Accident and Emergency.
Competing interests: None declared.
, http://www.100md.com
Ethical approval: Not needed.
References
Royal College of Paediatrics and Child Health. Accident and emergency services for children: a report of a multidisciplinary working party. London: RCPCH, 1999.
Royal College of Paediatrics and Child Health. Providing a service for children: workforce census 2001. London: RCPCH, 2003.
Action for Sick Children. Emergency health services for children and young people: a guide for commissioners and providers. London: ASC, 1997.
Carly SD, Jones M. Are we ready for the next major incident A review of hospital major incident plans. BMJ 1996;313: 1242-3.
Department of Health. Getting the right start: the national service framework for children, young people and maternity services: standard for hospital services. London: DoH, 2003., 百拇医药(R Salter, I K Maconochie)
Introduction
In June 1999 an intercollegiate working party of Royal College of Paediatrics and Child Health, British Association of Accident and Emergency Medicine (BAEM), British Association of Paediatric Surgeons, Faculty of Accident and Emergency Medicine, Royal College of Nursing (RCN), and Royal College of General Practitioners was established. Terms of reference were to review emergency services for children and to make recommendations for future provision of these services. The subsequent report—Accident and Emergency Services for Children (AESC)—made 32 recommendations (representing minimum levels of care), to be implemented by 2004.1
, http://www.100md.com
Participants, methods, and results
We sent questionnaires to lead emergency doctors (listed in the BAEM's directory of 2001-2) between Oct 2003 and Jan 2004 about the recommendations. Nonresponders were re-sent the questionnaire.
Of 219 departments with inpatient paediatric facilities,2 139 (63%) replied (table). In all, 47 (34%) of replying hospitals saw more than 18 000 children annually; 41 (87%) were district general hospitals. Only 64 (29%) departments with separate paediatric emergency facilities responded; the 71% that did not respond accounted for 47% of nonresponders, many seeing more than 18 000 children annually.
, http://www.100md.com
Facilities, function, and staffing of 139 UK paediatric emergency departments
Although currently 41 departments have separate paediatric emergency departments, 92% of children attend general departments; these show the largest differences from recommendations of the AESC report. In 1997, 10% of hospitals did not have inpatient services onsite3 now only 1.9% do not (minor injury units excluded).
Wards are safe for only the initial reception of emergency admissions if appropriately equipped and staffed for reception, triage, and resuscitation1; these criteria are often not met.
, http://www.100md.com
Assessing the severity of illness is essential, but a quarter of departments seeing more than 18 000 children a year do not have separate triage facilities, and 23% do not triage children with an appropriately trained nurse. Although the pain assessment tool and the national triage score are used widely, their effectiveness must be questioned where non-trained staff are triaging. Level 2 care, while awaiting a paediatric retrieval team (children's mobile intensive care unit), is delivered in 85% of departments, often at cost to emergency, paediatric, and intensive care services. The current trend of centralisation means that emergency staff must deliver this care, so there must be the appropriate mix of skills on duty.
, 百拇医药
In 1996, 30% of hospitals did not cater for children within major incident plans (required by the National Service Framework for children and young people)4 5; fewer now have children in their plans.
The National Service Framework expects emergency professionals to do courses in paediatric life support and to regularly update; currently, 47% of nurses do not attend such courses.
Comment
One in four patients presenting at emergency departments is a child. Child centred good quality care which is accessible at the right time is required, however there is considerable room for improvement in the care of children in emergency departments. This government has recognised unacceptable variations nationwide in the quality of care for children and wants to eliminate these differences (the National Service Framework).4 5 The framework allows adult nurses to care for children only within the limits of their knowledge and should be under direct supervision of a children's trained nurse. Recruitment and retention of nursing staff is a problem in emergency departments. The Royal College of Nursing recommends rotational posts with community nursing and paediatric wards. The number of applicants for training in children's nursing exceeds the number available, so structured investment in nurse training may provide the necessary skilled nurses.
, http://www.100md.com
What is already known on this topic
Paediatric emergency services were under resourced in the United Kingdom, a report in 1999 found; the report made recommendations for improvement
What this study adds
Current emergency services for children in the United Kingdom still fall short of these essential recommendations
The AESC recommends that hospitals seeing more than 18 000 children should have a consultant in paediatric emergency medicine by 2004 and in all emergency departments by 2010. This, along with many of the other AESC recommendations made five years ago, has not been met and without future investment in staffing and facilities a child centred service will be hard to achieve.
, 百拇医药
This article was posted on bmj.com on 3 December 2004: http://bmj.com/cgi/doi/10.1136/bmj.38313.580324.F7
The questionnaire is on bmj.com
Contributors: RS was the primary investigator. IKM was supervisor. IKM is guarantor.
Funding: St Mary's Hospital NHS Trust, department of Paediatric Accident and Emergency.
Competing interests: None declared.
, http://www.100md.com
Ethical approval: Not needed.
References
Royal College of Paediatrics and Child Health. Accident and emergency services for children: a report of a multidisciplinary working party. London: RCPCH, 1999.
Royal College of Paediatrics and Child Health. Providing a service for children: workforce census 2001. London: RCPCH, 2003.
Action for Sick Children. Emergency health services for children and young people: a guide for commissioners and providers. London: ASC, 1997.
Carly SD, Jones M. Are we ready for the next major incident A review of hospital major incident plans. BMJ 1996;313: 1242-3.
Department of Health. Getting the right start: the national service framework for children, young people and maternity services: standard for hospital services. London: DoH, 2003., 百拇医药(R Salter, I K Maconochie)