Quality of management of the pediatric patient admitted in the emergency room

Aim - By a prospective study authors tried to analyse the quality of manage ment of the pediatric patient admitted in the emergency department. Population and methods. - One hundred admission files were prospectively an alysed for characteristics of age (mean age: 70 months), effectiveness of m easurement of physiological parameters, evaluation of appropriateness of nu rsing management according to recorded parameters, length of stay in the em ergency department according to the need for hospitalization, blood tests, X-rays and the seniority of the attending medical staff. Results. - Parameters were not, or only incompletely, recorded in 65 bedlet ters. Although all were recorded in the remaining 35 files, subsequent mana gement was inadequate in seven cases. Mean length of stay in the emergency department was 116 minutes, influenced by the need for hospitalization (145 minutes compared to 102 minutes for the non-hospitalized children), timing of admission (mean: 125 minutes from 8 am to 6 pm, compared to 94 minutes from 6 pm to 8 am), need for blood tests, X-rays or both (mean: 122, 107 an d 170 minutes respectively, compared to 55 minutes when no complementary ex am was asked) and seniority of attending medical staff (mean: 65 minutes fo r permanent staff compared to 116 minutes for fellows). Conclusions. - Measurement of physiological parameters must be standard pra ctise in the management of pediatric patients admitted to the emergency dep artment and must lead to appropriate management without undue delay. In ord er to reach this goal, emergency departments should be more adequately staf fed with nurses and senior doctors specifically trained in the care of the pediatric patient. Blood tests and X-rays should be more readily available. (C) 1998 Elsevier, Paris.