Assessing structural quality elements of pediatric emergency care

Background and Objective: Emergency departments must have appropriate resources and equipment available tomeet the unique needs of children. We assessed the availability of stakeholder-endorsed quality structure performance measures for pediatric emergency department patients. Methods: A survey of Child Health Corporation of America member hospitals was conducted. Six broad equipment groups were queried: general, monitoring, respiratory, vascular access, fracture-management, and specialized pediatric trays. Equipment availabilitywas determined at the level of the individual item, 6 broad groups, and 44 equipment subgroups. The survey queried the availability of 8 protocol/procedure elements: method to identify age-based abnormal vital signs, patient-centered care advisory council, bronchiolitis evidence-based guideline, pediatric radiation dosing standards, suspected child abuse protocols, use of validated pediatric triage tool, and presence of nurse and physician pediatric coordinators. Results: Fifty-two percent (22/42) of sites completed the survey. Fortyone percent reported availability of all 113 recommended equipment items. Every hospital reported complete availability of equipment in 77% of the subgroups. The most common missing items were adult-sized lumbar puncture needles, hypothermia thermometers, and various sizes of laryngeal mask airways. Regarding the protocol/procedure elements, a method to identify age-based abnormal vital signs, pediatric radiation dosing standard, and nurse and physician pediatric coordinatorswere present in 100%. Ninety-five percent used a validated triage tool and had suspected child abuse protocols. Conclusions: Presence of necessary pediatric emergency equipment is better in the surveyed hospitals than in prior reports.Most responding hospitals have important protocol/procedures in place. These data may provide benchmarks for optimal care.