Emergency department readiness for pediatric illness and injury
There are approximately 25 million emergency department visits by children each year in the United States. It can be challenging for healthcare providers to maintain the readiness of emergency departments in terms of equipment availability, policies and procedures for the care of children, and quality improvement for pediatric patients. Nearly 90% of children are seen in general emergency departments, and 50% of emergency departments see fewer than 10 pediatric patients per day, resulting in somewhat limited experience with critically ill and injured children for most emergency care clinicians. In the framework of the current healthcare system that is wrought with overcrowding, underfunding, and highly variable pediatric capabilities, children are arguably at the greatest risk for medical error. This issue reviews the current state of pediatric readiness in emergency departments, the necessary steps to ensure day-to-day readiness, the published guidelines for pediatric readiness, and systems-based innovations in pediatric readiness.
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ABSTRACT: Background: There is an absence of data describing pediatric patients who visit Emergency Department (ED) in Thailand. Therefore, this report creates a profile of pediatric emergency room visit at a university hospital in Thailand. Material and method: The retrospective data of the pediatric patient aged less than 15 years that visited ED at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand between fiscal year (FY) 2002 and 2011 were reviewed. The Electronic Medical Record Tracking was extracted. Demographic characteristic, acuity level, timing, and presumptive diagnosis were reviewed. Results: During the 10 years of the data collection, 122,037 pediatric patient visited ED, thus, approximately 12,000 visits per year Pediatric patients account for an average of 18% of hospital patients. Medical condition accounted for 95.21% of the visits followed by trauma at 4.77%, and death at 0.02%. The triage categorized patients into critical, emergency, urgency, and non-emergency, consisting of 0.6% as critical patients, 37.6% as emergency patients, 52.5% as acute illness, and 9.3% as non-emergency patients. The three most common diagnosis were upper respiratory tract infection, acute febrile illness, and acute gastroenteritis. Patient usually visited ED in the evening shift 44% (4 p.m. to midnight), followed by morning shift 40% (8 a.m. to 4 p.m.), and overnight shift 16% (midnight to 8 a.m.). There were two highest peaks of ED visit, in June, during the rainy season, and in January, during the winter. Conclusion: Pediatric patients attending the emergency service were mostly for medical conditions. Acute illnesses were the major group ofpediatric patients. A small proportion of visits in ED were true emergencies.
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