Paediatric-appropriate facilities in emergency departments of community hospitals in Ontario: A cross-sectional study

doi:10.5847/wjem.j.1920-8642.2017.04.003

Abstract

Abstract:

BACKGROUND: We assessed whether the paediatric-appropriate facilities were available at Emergency Departments (ED) in community hospitals in a Canadian province.

METHODS: We conducted a cross-sectional survey of EDs in community hospitals in Ontario, Canada that had inpatient paediatric facilities and a neonatal intensive care unit. Key informants were ED chiefs, clinical educators, or managers. The survey included questions about paediatric facilities related to environment, triage, training, and staff in EDs.

RESULTS: Of 52 hospitals, 69% (n=36) responded to our survey. Of them, 14% EDs (n=5) had some separated spaces available for paediatric patients. About 53% (n=19) of EDs lacked children activities, e.g., toys. Only 11% (n=4) EDs were using paediatric triage scales and 42% (n=15) had a designated paediatric resuscitation bay. Only half of the ED (n=18) required from their staff to update paediatric life support training. Only 31% (n=11) had a designated liaison paediatrician for the ED. Paediatric social worker was present in only 8% (n=3) of EDs in community hospitals.

CONCLUSION: Most of the Ontario community hospital EDs included in this survey had inadequate facilities for paediatric patients such as specific waiting and treatment areas.

Key words: Child-friendly, Environment, Survey, Triage, Waiting area

Muhammad Akhter Hamid, Sohaib Siddiqui, Jabeen Fayyaz, Ayesha Chandna, Aliya Ariz, Joe Butchey, Elancheliyan Ambalavanar, Niraj Mistry, Aftab Muhammad Azad, Junaid A. Bhatti, Dennis Scolnik. Paediatric-appropriate facilities in emergency departments of community hospitals in Ontario: A cross-sectional study[J]. World Journal of Emergency Medicine, 2017, 8(4): 264-268.

Figures/Tables 2

Table 1

Survey questionnaire

Questionnaire items
1) Configuration of the ED (i.e. combined or separated entrances) for pediatric patients.
a) Separate pediatric area with a separate pediatric entrance to the ED
b) Separate pediatric area with a common entrance to the ED
c) Combined areas for both pediatric and adult patients (children and adults being managed in the same department)
d) Other. Please describe your ED configuration for the care of children
2) Estimate of total annual volume of patients seen at your ED.
a) <25 000
b) 25 000-49 999
c) 50 000-74 999
d) 75 000-100 000
e) >100 000
3) Estimate of total annual volume of pediatric patients seen at your ED.
a) <5 000
b) 5 000-9 999
c) 10 000-14 999
d) 15 000-19 999
e) >20 000
4) Is there a separate child-specific waiting area in your ED?
a) Yes
b) No
5) Is there a separate child-specific treatment area in your ED?
a) Yes
b) No
6) Does your hospital ED provide spaces for the following: breast feeding/diaper changing/child-friendly washrooms? (Please indicate which ones apply to your hospital)
a) Breast feeding
b) Baby changing
c) Child-friendly washrooms
d) None of the above
7) In your ED, are there age-appropriate toys and activities for toddlers/ children/teenagers?
a) All ages
b) Toddlers only
c) Children only
d) Teenagers only
e) None of the above
8) Does your hospital's ED have a pediatric emergency care trolley/bag available?
a) Yes
b) No
9) Does your hospital's ED have a designated resuscitation bay for pediatric patients?
a) Yes
b) No
10) Does your hospital's ED have 24/7 access to the following attending physicians: adult emergency physician/ physician with interests in paediatrics/ pediatric emergency medicine physician/ paediatrician with a special interest in emergency medicine/ paediatrician?
a) Adult emergency medicine physician
b) Adult emergency medicine physician with interest in pediatrics
c) Pediatric emergency medicine physician
d) Pediatrician with a special interest in emergency medicine
e) Pediatrician
11) Does the hospital have a designated liaison paediatrician for the ED?
a) Yes
b) No
12) Is it mandatory for the ED staff to have their pediatric life support training updated according or national guidelines?
a) Yes
b) No
13) Does the department conduct/support refresher courses (e.g. neonatal resuscitation program/pediatric advanced life support/ advanced trauma life support) ?
a) Neonatal Resuscitation Program (NRP)
b) Pediatric advanced life support (PALS)/advanced pediatric life support (APLS)
c) Advance trauma life support (ATLS)
d) None of the above
Questionnaire items
14) How many nurses trained in paediatrics are present in your hospital's ED during a shift?
a) 1-3
b) 4-6
c) >6
d) None
15) Does your hospital's ED have acute pediatric order sets or guidelines tailored to your hospital/facility?
a) Yes
b) No
16) Which type of triage system is utilized at your hospital (Canadian triage and acuity scale/pediatric Canadian triage and acuity scale/ emergency triage assessment and treatment/simple triage and rapid treatment/emergency severity index)?
a) Canadian Triage & Acuity Scale (CTAS)
b) Pediatric Canadian Triage & Acuity Scale (P-CTAS)
c) Emergency Triage Assessment & Treatment (ETAT)
d) Simple Triage and Rapid Treatment (START )
e) Emergency Severity Index (ESI)
f) Other (please specify)
17) Is there an established ED protocol for managing pain using topical anaesthesia e.g. EMLA or maxilene before I.V. line insertion and blood work?
a) Yes
b) No
18) Does your hospital's ED have designated pediatric social workers?
a) Yes
b) No
19) Does your hospital have child life programs/specialists available to support children and families during difficult procedures and situations?
a) 24-hour services available
b) Peak time availability
c) On-call for difficult cases
d) None of the above
20) Are ED staff provided with training regarding child protection?
a) Yes
b) No
21) Are trained interpreter services (telephone/in person) available for families with language barriers?
a) Yes
b) No
22) Are visitor identification badges/bands provided to families with children?
a) Yes
b) No
23) Are there parent/patient satisfaction common forms available?
a) Yes
b) No
24) In your hospital, are there plans to develop a separate pediatric area with child-tailored facilities?
a) Yes
b) No
c) Do not know
d) If yes, when? (year)
25) Do you feel that having access to standardized guidelines for managing pediatric patients in the emergency departments of community hospitals would be beneficial in providing the highest quality of care for children across Canada?
a) Yes
b) No
c) Please write your comments or feedback

Table 1

Table 2

Paediatric facilities availability at Emergency Departments (ED) of community hospitals in Ontario, Canada

Questionnaire items	n	%
Total ED patients per year
<25 000	2	6
25 000-49 999	10	28
50 000-74 999	14	39
75 000-100 000	7	19
>100 000	3	8
Paediatric patients per year
<5 000	5	14
5 000-9 999	11	31
10 000-14 999	7	19
15 000-19 999	6	17
>20 000	4	11
Configuration of ED
Separate paediatric space and entrance	1	3
Separate paediatric space but common entrance	3	8
Same space and entrance	30	83
Others	2	6
Child-specific waiting area	5	14
Child-specific treatment area	5	14
Space available for
Breast feeding	9	25
Baby changing	18	50
Child-friendly washrooms	4	11
None of the above	16	44
Plans of separate paediatric facilities
Yes	7	19
No	21	58
Do not know	8	22
Age-appropriate toys/activities available
All ages	3	8
Toddlers only	9	25
Children only	12	33
Teenagers only	3	8
None of the above	19	53
Paediatric emergency care trolley/bag available	28	78
Designated resuscitation bay for paediatric patients	15	42
Designated liaison paediatrician for the ED	11	31
Mandatory paediatric life support training for ED staff	18	50
Departmental support for refresher courses
Neonatal Resuscitation Program (NRP)	19	53
Paediatric advanced life support (PALS)	29	81
Advance trauma life support (ATLS)	10	28
None of the above	4	11
Nurses trained in paediatrics in ED
1-3	14	39
4-6	4	11
>6	8	22
None	10	28
Acute paediatric order set or guidelines	22	61
Triage system at hospital
Canadian Triage & Acuity Scale (CTAS)	31	86
Paediatric Canadian Triage & Acuity Scale (P-CTAS)	4	11
Other (please specify)	1	3
ED protocol for managing pain in paediatric patients	20	56
Designated paediatric social worker(s)	3	8
Child life program/specialist(s) for difficult procedures
24-hour services available	1	3
Peak time availability	4	11
On-call for difficult cases	1	3
None of the above	30	83
Child protection training	20	56
Trained interpreter services	33	92
Visitor identification badges for families	2	6
Patient satisfaction forms available	26	72
Need of paediatric specific guidelines for ED facilities	34	94

Table 2

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