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Instrument Question #10

10. Which of the following best describes your hospital? (Choose one)

  • General Hospital (a non-specialized facility treating adults and children for all medical and trauma conditions with or without a separate pediatric ED)
  • Children’s Hospital within a General Hospital (children’s hospital located completely within a larger hospital which also sees adults)
  • Children’s Hospital (a stand-alone, specialized facility which offers services exclusively to children and adolescents)
  • Critical Access Hospital (a non-specialized facility that is typically 35 miles from another hospital and maintains no more than 25 inpatient beds)
  • Micro-Hospital (small scale inpatient facility that typically maintains 8 to 15 beds for observation and short-stay use for low-acuity patients)
  • Off-Site Hospital-Based or Satellite Emergency Department (a facility
    providing emergency department services, basic imaging, and laboratory services)
  • Independently-Owned Freestanding Emergency Department (a standalone facility providing emergency department services, basic imaging, and laboratory services)
  • Other

I am struggling to choose a category for my hospital type. Can you provide additional clarification?

Below are some examples for additional context:

  • A General Hospital directly adjacent to a Children's Hospital – If it is a separate ED from the children’s hospital it should be General Hospital. It is a Children’s hospital if it has a combined ED
  • Children's Hospital which also offers OB services is still considered a Children’s Hospital
  • Specialty hospital with an emergency room – It might be best to select ‘Other’ especially if it is a Shriner’s hospital or Orthopedic hospital with ED

The definition of micro-hospital as it appears in the survey for question #10 is not accurate for our facilities.  We are a fully licensed hospital with both an emergency department and inpatient facilities. I am not certain which to choose for what best describes the facility. Should I choose “other?”

The definition of hospitals on the assessment was generalized to capture a national range of hospital demographics. It is understandable that our definition may not include added measures defined by your hospital. Consult with your ED leadership and choose which definition best fits your ED. If you really do not know, feel free to put ‘Other’.

Instrument Question #18-21

18. Which of the following inpatient services does your hospital have on-site? (Check Yes or No for each)

a. Newborn nursery                     Yes   No

b. Neonatal intensive care unit   Yes   No

c. Pediatric intensive care unit    Yes   No

d. Pediatric step-down unit         Yes   No

e. Pediatric inpatient ward          Yes   No

f. Adult intensive care unit (medical or surgical) Yes No

g. Adult step-down unit              Yes   No

h. Adult inpatient ward               Yes   No

(see questions 19-21 on the assessment for further context)

We do not currently section off our emergency department for specific populations but do provide these services.  We would not say we have an “adult unit/ward” or this is the “pediatric unit”. We would say, “This is our intensive care unit.”  We have newborn beds, pediatric equipment, and provide these specific services just not in a separate location. Does that qualify as a 'yes' or 'no' response? 

This question implies dedicated space that is designed for children; Therefore, if there is dedicated Newborn Nursery the answer is Yes – if indeed there are no dedicated areas for children but beds are used for adults and children, the answer to 18 for pediatric questions are “No”; 19-21 would be “Yes” (see questions 19-21 on the assessment for further context). 

Instrument Question #19-21

19. Does your hospital ever admit children to the adult intensive care unit (medical or surgical)?                 Yes   No

20. Does your hospital ever admit children to the adult step-down unit?

                                                     Yes   No

21. Does your hospital eve3r admit children to the adult inpatient ward?

                                                     Yes   No

Does your hospital ever admit children to the adult intensive care unit (medical or surgical); Adult step down unit; Adult inpatient ward:  This may occur very seldom; that patient would still be managed under the appropriate pediatric provider.  Would we answer this a yes?

Yes, you should answer yes even if this only rarely occurs.

Instrument Question #22-27 (Physician & Nurse Pediatric Emergency Care Coordinators)

22. Does your ED have a physician coordinator—sometimes referred to as a pediatric emergency care coordinator (PECC) or pediatric champion—who is assigned the role of overseeing various administrative aspects of pediatric emergency care (e.g., oversees quality improvement, collaborates with nursing, ensures pediatric skills of staff, develops and periodically reviews policies)? (Choose one):

Note: The physician coordinator for pediatric emergency care may have additional administrative roles in the ED.

  • Our ED has a physician coordinator that is filled by an MD or DO
  • Our ED has a physician coordinator that is filled by an Advanced Practice Provider (e.g., Physician Assistant or Nurse Practitioner) with physician oversight
  • Our ED does NOT HAVE a physician coordinator at this time                Skip to Question 25

(see question #23-27 on the assessment for further context)

Our hospital has individuals that have some of these roles described as part of their current responsibility, but they are not hired just to fulfill these tasks alone.  These individuals are also not called physician/ nurse coordinators or pediatric emergency care coordinators.   For example, I do many of these tasks, but I am not considered a nurse coordinator nor a pediatric emergency care coordinator.  

If indeed there is a physician and/or nurse who is assigned the role of addressing pediatric-specific issues and ensuring pediatric specific needs are integrated into care processes, then the answers about physician and/or nurse pediatric care coordinators are “Yes.” This role need not be full-time. The responsibilities may be a shared role among more than one individual or assigned within another position/title. However, pediatric-specific responsibilities should be clearly delineated.

Instrument Question #28 

  1. Is there a physician working on-site in the ED 24/7?  Yes   No

We have this planned, but if I am being honest it does not happen due to weather and flights cancellations coming in-out of our community.  Every physician is flown in to complete each shift. I would like to answer 24/7 because that is the idea.  Also, if I choose “NO” this assessment skips out in collecting information about the physicians who staff the ED. Don’t they want to know this?

If the intent is to staff the ED 24/7 and there is a back-up plan to ensure coverage then the Answer is “Yes” and continue to question 29. Please answer how you feel best describes your facility. currently.  

Instrument Question #29

29. If yes, what types of training/certification are required for physicians who staff your ED 24/7 and care for children? (Check Yes or No for each)

a.  Emergency medicine board eligible/certified  Yes   No

b.  Pediatric emergency medicine board eligible/certified  Yes   No

c.  Pediatrics board eligible/certified  Yes   No

d.  Family medicine board eligible/certified  Yes   No

e.  Internal medicine board eligible/certified  Yes   No

f.  Surgery board eligible/certified  Yes   No

g.  Board eligible/certified physician with other training  Yes   No

h.  Non-Board eligible/certified physician with other training  Yes   No

 How do you answer this question if the physicians are required to be board certified for at least one of the specialties? But not all on the list? 

In answering this question, please consider the types of training that those physicians who are allowed to practice in your ED in the care of children have.  Please answer a-h individually to ensure that all training types have been identified, as you may have a mix of physician types as your ED providers. This question is not a scored item, but is very helpful to understand the training of physicians caring for children.

Instrument Question #34-36

Does your hospital have a policy for nurse credentialing that requires pediatric specific competencies for working in the ED (e.g., continuing education requirements, maintenance specialty certifications, hospital specific competency, evaluations)?  Yes   No

If yes, which of the following are required?

35. Continuing education requirements in pediatric emergency care (e.g., ENPC, PALS)                                       Yes   No

36. Maintenance of specialty certification for nurses (e.g., CEN, CPEN)
                                                            Yes   No

[Our] ED nurses have to complete PALS, and get signed off on using emergency pediatric equipment.  Does this count toward these questions? 

In Q34, PALS counts toward continuing education. PALS would not be considered a specialty certification or part of a competency evaluation.

We understand that PALS is not considered a specialty certification nor is it a competency evaluation.  Does TNCC, NALS or NRP qualify as a specialty certification for question 35? 

PALS, NRP, TNCC, NALS are continuing education programs; they provide a completion card but these do not qualify as certification for physicians and nurses. Some credentialing programs may require these courses as a part of credentialing but we do not consider them competencies.

See ENA position statement on certifications:

   "Specialty certification is a method for validating the knowledge, skills, and competencies unique to specific populations...  Specialty certifications are overseen by a Board of Certification that administers specialty nursing certification programs for emergency nurses. Certification is attained by passing the exam. Emergency nurses may attain specialty certification by exam through the Board of Certification for Emergency Nursing (BCEN) as a generalist (CEN), flight nurse (CFRN), critical care ground transport nurse (CTRN), pediatric emergency nurse (CPEN) and trauma nurse (TCRN). Emergency nurse practitioners may attain an Emergency Nurse Practitioner Certification (ENP-C) through a program offered by the American Academy of Nurse Practitioners in collaboration with the American Academy of Emergency Nurse Practitioners."  

Once attained, certification renewal requires ongoing demonstration of a specific number of patient contact hours and/or continuing education requirements outside of the course itself. 

Instrument Question #43-44

43. Does your ED have a Quality Improvement/Performance Improvement Plan for pediatric patients? (e.g., chart review, collection of pediatric emergency care data, development of a plan to improve pediatric emergency care)

Note: This may be a separate Quality Improvement/Performance Improvement Plan for pediatric patients or integrated into the overall ED Quality Improvement/Performance Improvement Plan.

Yes   No

(see question 44 on the assessment for further context)

Do we have to have a separate QA/QI plan just for pediatrics? Our current QA/QI plan already includes pediatric patients.

This may be a separate Quality Improvement/Performance Improvement Plan for pediatric patients or integrated into the overall ED Quality Improvement/Performance Improvement Plan.  However, pediatric-specific elements should be clearly defined.  Please see the note included under question 43 for examples.  

Instrument Question #79-81 

Please provide actual data or estimations of ED patient volume for the following:
79. Estimate the total number of patients (adult and pediatric) seen in your ED in the last year. (Numeric data only, e.g., 5000, not "five thousand") 
Number of Total Patients ____________________________ 

80. Estimate the number of pediatric patients (as defined by your hospital) seen in your ED in the last year. (Choose one)

  • Low: <1,800 pediatric patients (average of 5 or fewer a day)
  • Medium: 1,800 – 4,999 pediatric patients (average of 6-13 a day)
  • Medium to High: 5,000 – 9,999 pediatric patients (average of 14-26 a day)
  • High: >=10,000 pediatric patients (average of 27 or more a day)

81. If you know the actual number or a more precise estimate of pediatric patients seen in your ED in the last year, please record the number below. (Numeric data only, e.g., 500, not “five hundred”)
Number of Pediatric Patients: _____________________ (not required)

Does this mean, 1 year from the date we take the assessment? Is 2020 data ok?

If the participant has ready access to ED patient volume statistics, it would be ideal to list the annual patient volume for the most recent 12-month cycle. This need not be a calendar year but the most recent 12-month period for which data was collected.  However, some participants may not have access to the exact number in which case an estimate of the average number of patients seen in a 12mo cycle is perfectly fine.

What if my hospital recently opened? 

You can extrapolate the annual volume based on the number of months open.  For example, if your hospital has seen 1000 patients in 3mos then the annual volume would be 4000. 

Note that if your new hospital took over an old hospital, the overall annual volume may not vary much from the prior institution.  

Instrument Question #86

Please choose the resources which you feel are needed to improve staff

comfort/preparedness to care for children in the ED. (Check all that apply) (not required)

a. Access to education for all staff caring for children (e.g., educational
webinars/learning modules)

b. Incentives for staff who improve pediatric emergency care for children in
your ED

c. Access to simulation/mock codes to care for children

d. Access to team training with all health care providers impacting pediatric
emergency care

e. Other

Incentives for staff who improve pediatric emergency care for children in your ED:  Can you provide an example of what you mean?

Examples could be a monthly/quarterly/annual award to recognize providers improving pediatric care (like “pediatric champion of the month” or “ED pediatric nurse of excellence of the year”; could be a small gift such as a gift card or tee-shirt; could be a recognition system (i.e., staff is named onto the pediatric resuscitation team that responds to sick peds kids or peds codes).

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