Pediatric Care Recommendations for Freestanding Urgent Care Facilities

Pediatric Care Recommendations for Freestanding Urgent Care Facilities – American Academy of Pediatrics Committee on Pediatric Emergencies

Freestanding urgent care facilities remain a fixture in provision of health services in a managed care environment. Although the Academy does not approve of the routine use of urgent care facilities because it detracts from the medical home concept,[1,2] the use of these facilities as part of urgent and emergent care systems is increasing in the managed care environment. The term urgent care may imply to the public that a facility is capable of managing critical or life-threatening emergencies. Therefore, these facilities must have the capability to identify patients with emergency conditions, stabilize them, and provide timely access to definitive care should critically ill or injured children need care. Urgent care facilities must have appropriate pediatric equipment and staff trained and experienced to provide critical support for ill and injured children until transferred for definitive care. It is necessary for urgent care facilities to have prearranged access to comprehensive emergency services through transfer and transport agreements to which both facilities adhere. Available and appropriate modes of transport should be identified in advance.

When after-hours urgent care clinics are used as a resource for pediatric urgent care, they should solicit help from the pediatric professional community, and pediatricians should be accessible who are prepared to assist in the stabilization and management of critically ill and injured children. Pediatricians responsible for managing the health care of children may occasionally need to use the resources of urgent care facilities after hours. When such clinics are recommended to patients, pediatricians should be certain that the urgent care center is prepared to stabilize and manage critically ill and injured children.

RECOMMENDATIONS

Urgent Care Facility Emergency Preparedness

1. The provision of properly trained nursing and allied health personnel consistent with those required for a standby facility as defined by American Academy of Pediatrics guidelines for pediatric emergency care facilities.[3]

2. Have all necessary resuscitation drugs, equipment, and supplies as detailed in the “Guidelines for Pediatric Equipment and Supplies for Emergency Departments” from the Committee on Pediatric Equipment and Supplies for Emergency Departments, National Emergency Medical Services for Children Resource Alliance.[4]

3. Staffing by a physician with training, experience, and skills necessary for pediatric advanced life support.

4. Prearranged triage, transfer, and transport agreements with a definitive care facility that is capable of providing comprehensive care to ill and injured children.

5. A mechanism for notifying the primary care physician or another on call health care professional about the treatment given, and arranging for appropriate follow-up with the child’s medical home.

6. An organized and structured quality improvement program that is consistent with the expectations for a standby facility for pediatric emergency care.[3]

Pediatrician’s Role in Urgent Care Facilities

1. Monitor the quality of pediatric care provided by urgent care facilities used by his/her patients for after-hours care.

2. Ensure that the urgent care facility has been provided necessary clinical information, and be available to provide consultation when referring a patient.

If freestanding urgent care centers are properly staffed and equipped and have appropriate triage, transfer, and transport guidelines, the safety of children using these services for emergencies can be protected?

COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE,

1998-1999

Robert A. Wiebe, MD, Chairperson

Barbara A. Barlow, MD

Ronald A. Furnival, MD

Barry W. Heath, MD

Steven E. Krug, MD

Karin A. McCloskey, MD

Lee A. Pyles, MD

Deborah Mulligan-Smith, MD

Timothy S. Yeh, MD

LIAISON REPRESENTATIVES

Richard M. Cantor, MD

American College of Emergency Physicians

Dennis W. Vane, MD

American College of Surgeons

Jean Athey, PhD

Maternal and Child Health Bureau

David Markenson, MD

National Association of EMS Physicians

SECTION LIAISONS

Joseph P. Cravero, MD

Section on Anesthesiology

M. Douglas Baker, MD

Section on Emergency Medicine

Michele Moss, MD

Section on Critical Care

Dennis W. Vane, MD

Section on Surgery

REFERENCES

[1.] American Academy of Pediatrics, Ad Hoc Task Force on Definition of the Medical Home. The medical home. Pediatrics. 1992;90:774

[2.] American Academy of Pediatrics, Ad Hoc Task Force on Definition of the Medical Home. The medical home statement addendum: pediatric primary health care. AAP News. November 1993

[3.] American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. Guidelines for pediatric emergency care facilities. Pediatrics. 1995;96:526 -537

[4.] Committee on Pediatric Equipment and Supplies for Emergency Departments, National Emergency Medical Services for Children Resource Alliance. Guidelines for pediatric equipment and supplies for emergency departments. Ann Emerg Med. 1998;31:54-57

[5.] Zimmerman DR, Applebaum D. Quality of pediatric care at a freestanding emergency facility. Pediatr Emerg Care. 1992;8:265-267

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

COPYRIGHT 1999 American Academy of Pediatrics

COPYRIGHT 2004 Gale Group