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How to Keep Kids Safer in General Emergency Departments

December 5, 2022

Written by Julie Brown

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This is a joint policy statement by the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA) to optimize safety in the care of pediatric patients in emergency care settings.

Why does this matter?
Critical care is challenging. Critically ill and injured children are even more so. Most pediatric emergency care occurs in general EDs who care for adult and pediatric patients. This statement highlights how we can optimize pediatric patient safety in these settings.

Kids are not just “tiny adults”
This is a revision of the 2007 AAP policy statement “Patient Safety in the Pediatric Emergency Care Setting” and the first joint statement by the AAP, ACEP, and ENA to address the delivery of safe care for pediatric patients in all emergency care settings.

Here are select interventions and initiatives suggested in the policy statement:

  • Leadership: Prioritize pediatric safety through ED resource allocation. Establish quality and safety committees, and include pediatric team members.
  • Patient and Family-Centered Care: Designate specific areas within general EDs dedicated to pediatric patients that support safety (i.e. out of reach sharps containers, cabinet locks). Train staff members on distraction and pain-reducing strategies. Involve child life specialists as care team members; expand interpreter services.
  • Patient Safety: Implement 5-level triage system. Utilize pediatric-specific order sets and evidence-based clinical pathways. Advocate for increased pediatric primary care and behavioral health services. Support multidisciplinary team-based training programs in communication (including simulation). Use structured handoffs. To minimize pediatric medication dosing errors, develop a standard pediatric formulary, and integrate ED pharmacists when able.
  • Clinician Support: Consider clinician wellness as an integral factor for pediatric patient safety, and invest in wellness initiatives for all team members.

There are innumerable differences between care for adult emergency patients and pediatric emergency patients, and these differences extend into operational, cultural, and safety domains. Recognizing these distinctions will equip emergency care teams, particularly those who care for adult and pediatric patients in the same physical environment, to identify opportunities for improvement in their own departments and to implement changes to support the culture of safety for pediatric patients.

Optimizing Pediatric Patient Safety in the Emergency Care Setting. Pediatrics. 2022 Oct 3;e2022059673. doi: 10.1542/peds.2022-059673. Online ahead of print.

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