Goal: By 2022, 50 percent of hospitals are recognized as part of a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric trauma.
Significance of the Measure:
The performance measure emphasizes the importance of the existence of a standardized statewide, territorial, or regional system of care for children that includes a recognition program for hospitals capable of stabilizing and/or managing pediatric trauma emergencies. A standardized recognition and/or designation program, based on compliance with the current published pediatric emergency and trauma care guidelines,1 contributes to the development of an organized system of care that assists hospitals in determining their capacity and readiness to effectively deliver pediatric emergency, trauma, and specialty care.
This measure addresses the development of a pediatric trauma recognition program. Recognition programs are based upon state-defined criteria and/or adoption of national current published pediatric emergency and trauma care consensus guidelines1 that address administration and coordination of pediatric care; the qualifications of physicians, nurses, and other ED staff; a formal pediatric quality-improvement or monitoring program; patient safety; policies, procedures, and protocols; and the availability of pediatric equipment, supplies, and medications.
Additionally, EMSC 05 does not require that the recognition program be mandated. Voluntary facility recognition is accepted. However, the preferred status is to have a program that is monitored by the state or territory.
This measure emphasizes the need for state and territory trauma systems to have a process in place that assures facilities providing pediatric trauma care have been verified as having integrated appropriate resources addressing the unique needs of children.
State trauma systems have existed in the United States in some organized fashion since the early 1970s and have been championed by the Institute of Medicine as a model for delivery of care for traumatic injury.2 Considering that traumatic injury is one of the most significant public health issues facing children, disparities in equipment, supplies, and training is concerning. Currently available research has not conclusively determined what the best type of trauma system or center is; however, research has identified “current gaps and disparities in the care of injured children that can be remedied through education and training.”3
The 2013 National Pediatric Readiness Assessment (see National Pediatric Readiness Project below) identified that not all emergency departments in the United States have the essential guidelines and resources in place to provide effective care to children.4 This assessment, based on “Guidelines for Care of Children in the Emergency Department,”1 scored hospitals on a scale from 0 to 100 based on a modified Delphi method developed by a group of clinical experts. Throughout the nation, emergency departments received a median score of 69 out of 100, indicating a need for improvement in the emergency care of children.
The Emergency Medical Services for Children Program continues to champion efforts to ensure that the ability to stabilize and/or manage pediatric trauma is fully integrated into all trauma systems. Most states have trauma systems in place that are either verified by the American College of Surgeons (ACS) Committee on Trauma (COT) or that are based on similar criteria.
1 American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, & Emergency Nurses Association Pediatric Committee (2009). Joint policy statement—guidelines for care of children in the emergency department. Pediatrics, 124(4), 1233–1243.
2 Carr, B. G. & Nance, M. L. (2010). Access to pediatric trauma care: alignment of providers and health systems. Current Opinion in Pediatrics, 22(3), 326–331.
3 Petrosyan, M., Guner, Y. S., Emami, C. N., & Ford, H. R. (2009). Disparities in the delivery of pediatric trauma care. Journal of Trauma, 67(2 Suppl), S114–119.
4 Gausche-Hill, M., Ely, M., Schmuhl, P., Telford, R., Remick, K. E., Edgerton, E. A., & Olson, L. M. (2015). A National assessment of pediatric readiness of emergency departments. JAMA Pediatrics, 169(6), 527–534.