Facility Categorization Toolbox


Hospitals and emergency departments are not alike: in addition to basic services, individual facilities may also specialize in the provision of certain types of care or specific clinical conditions. The concept of categorizing healthcare facilities with regard to specialized capabilities and/or resources is not new: trauma, burn, perinatal, and stroke centers have existed for years or even decades. Facility categorization has also become associated with regionalization, the notion of identifying available health resources within a given area and coordinating healthcare services to meet the needs of specific patient populations.

The 2006 Institute of Medicine (IOM) report Emergency Care for Children: Growing Pains support the categorization of emergency care for children. Experts agree that a categorization system for hospitals capable of providing essential resources for children should have the following services in place:

  • pediatric-specific equipment;

  • caregivers (i.e. nurses and physicians) trained in pediatric emergency/resuscitation care;

  • pediatric-specific policies and protocols;

  • a system in place for monitoring pediatric care and performance improvement;

  • organized transfer processes, such as interfacility agreements and guidelines facilitating movement of pediatric patients and resources as necessary; and

  • processes to assure family integration

Note: The EMSC NRC has developed separate toolboxes on Pediatric Equipment, Family-centered Care, and Interfacility Transfer. Please review these toolboxes for additional resources that may also apply to the broader term "facility categorization."

HEALTHCARE PROVIDER RESOURCES

EMSC National Resource Center

  • EMSC State Partnership Performance Measures address operational capacity to provide pediatric emergency care, including the existence of a standardized statewide, territorial, or regional system that recognizes hospitals capable of stabilizing and /or managing pediatric medical emergencies 

More details about this and other provider resources.

EXAMPLE PRACTICES

Illinois EMSC Facility Recognition Program  Since 1998, more than 100 Illinois hospitals (including two in Iowa) have received recognition by the Illinois Department of Public Health and the Emergency Medical Services for Children Program through the Illinois EMSC Facility Recognition initiative

More details about this and other example practices.

DATABASE SEARCHES

National Library of Medicine PubMed journal article database

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FAMILY AND CAREGIVER RESOURCES

American College of Emergency Physicians

  • Emergency Care of Children. This fact sheet answers questions that parents may have about emergency care for children, such as:...

More details about this and other family and caregiver resources.

HEALTHCARE PROVIDER RESOURCES

EMSC National Resource Center (NRC)

  • EMSC State Partnership Performance Measures. To measure the effectiveness of federal grant programs, the Health Resources and Services Administration (HRSA) requires grantees to report on specific performance measures related to their grant funded activities. The measures are part of the Government Performance Results Act (GPRA).

    EMSC performance measures address operational capacity to provide pediatric emergency care, including the existence of a standardized statewide, territorial, or regional systems that recognize hospitals capable of stabilizing and /or managing pediatric medical emergencies and trauma (see PMs 74 and 75). (Accessed November 2011).

  • Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures. This EMSC NRC booklet contains additional information regarding the EMSC State Partnership performance measures, and includes best practices from state activities related to facility categorization, as well as interfacility transfer agreements. (June 2009).
  • EMSC Webcasts. This section of the EMSC NRC website includes links to upcoming and archived webcasts, including the following:
  • Joint Policy Statement for Guidelines for Care of Children in the Emergency Department. Endorsed by the AAP’s Committee on Pediatric Emergency Medicine, ACEP’s Pediatric Committee, and ENA’s Pediatric Committee, these guidelines outline the essential resources (medications, equipment, policies, and education) and staff to ensure that hospital emergency departments are prepared to care for children of all ages, from neonates to adolescents. The guidelines are consistent with the recommendations of the IOM 2006 report Future of Emergency Care in the United States Health System, and are also available online through the ACEP website (Published in Pediatrics September 2009).

    • Guidelines Checklist. In accordance with the AAP, ACEP, and ENA 2009 Guidelines for Care of Children in the ED, this checklist allows healthcare facilities to assess their own preparedness to manage pediatric emergencies. (2010).

  • Pediatric Regional Critical Care Hospitals: White Paper on Evidence and Improvement Opportunities in New York. This White Paper reports on an evaluation of pediatric critical care services undertaken by the New York State EMSC Advisory Committee. The White Paper summarizes published research regarding outcomes at high volume pediatric regional critical care hospitals versus other facilities. Potential barriers interfering with access to pediatric critical care facilities in New York are described. The paper also offers approaches that should be considered for improvement of critical care services for children in New York. One of the recommendations from this White Paper includes establishing an “authority and a process necessary to designate facilities appropriate for pediatric critical care.” (February 2008).


American Academy of Pediatrics

  • AAP News: Policy Offers Blueprint for Care of Children in the ED. This AAP commentary piece provides background information and a concise summary of the key recommendations contained in the 2009 Guidelines for Care of Children in the Emergency Department. (November 2009).

  • Summary of Guidelines for Care of Children in the Emergency Department. This PowerPoint presentation summarizes the Joint Policy statement of the Guidelines for Care of Children in the Emergency Department. (Accessed November 2011).

  • Clinical Report: Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital. This Clinical Report provides guidance to community hospitals on essential furnishing, equipment, policies/procedures, referral networks, and transfer arrangements for the care of pediatric patients. (September 2007).
  • Consensus Report for Regionalization of Services for Critically Ill or Injured Children. A joint publication of the AAP and the pediatric sections of the American College of Critical Care Medicine (ACCCM), this document establishes recommendations for regionalized, integrated emergency medical care for critically ill or injured children. (January 2000).

  • Pediatric Care Recommendations for Freestanding Urgent Care Facilities. Given that free standing urgent care centers may be used as an alternative to hospital emergency departments, this policy statement of AAP’s Committee on Pediatric Emergency Medicine addresses recommendations and resources for assuring appropriate stabilization in pediatric emergency situations and timely transfer to a hospital for definitive care when necessary. (Reaffirmed September 2011).

  • Management of Pediatric Trauma. This article states that improving outcomes for the injured child requires an approach that recognizes childhood injury as a significant public health problem. Efforts should be made to improve injury-prevention programs, emergency medical care, and trauma systems for pediatric patients. The pediatric trauma system functions best as part of the inclusive EMS, trauma, and disaster response system for the region or state. It has been shown that younger and more seriously injured children have better outcomes at a trauma center within a children’s hospital or at a trauma center that integrates pediatric and adult trauma services. (April 2008).


Centers for Disease Control and Prevention, U.S. Department of Health and Human Services

  • Availability of Pediatric Services and Equipment in Emergency Departments: United States, 2002-03. Containing the results of the Emergency Pediatric Services and Equipment Supplement to the Centers for Disease Control and Prevention’s 2002-3 National Hospital Ambulatory Medical Care Survey, this report presents estimates on the availability of pediatric services, expertise, and supplies for treating pediatric emergencies in U.S. hospitals. Results indicate that emergency departments in hospitals with specialized inpatient facilities for children are more likely to meet the AAP/ACEP guidelines for pediatric emergency care capabilities. (February 2006).


Clinical Pediatric Emergency Medicine

  • Pediatric Patients in the Adult Trauma Bay–Comfort Level and Challenges. “Most pediatric trauma patients are cared for in non-children's hospitals by providers without pediatric specialty training and in facilities that may not be used to caring for children. Children have different physiologic and psychologic responses to injury than adults. Several studies have shown that pediatric trauma patients have improved outcomes with lower mortality, fewer operations, and improved function when cared for in pediatric facilities or adult trauma centers with pediatric expertise. Limitations in the availability of pediatric specialists require that all hospitals be prepared to effectively and successfully treat pediatric trauma patients.” (Clinical Pediatric Emergency Medicine, Vol 11, Issue 1, pp 48-56, March 2010).


Emergency Nurses Association

  • Care of the Pediatric Patient in the Emergency Setting. This position statement articulates ENA’s support for emergency departments seeking designation as: emergency pediatric centers, emergency departments approved for pediatrics, and stand-by emergency departments for pediatrics, or similar designations as determined by individual states. (May 2007).


Institute of Medicine

  • Emergency Care for Children: Growing Pains. The IOM Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S. and to create a vision for the future of emergency care. In 2006, the committee released “Growing Pains,” an analysis of: (1) the role of pediatric emergency services as an integrated component of the overall health system; (2) system-wide pediatric emergency care planning, preparedness, coordination, and funding; (3) pediatric training in professional education; and (4) research in pediatric emergency care. With its call for an over-arching system of emergency care that is coordinated, regionalized, and accountable, this publication contains numerous references to the need for pediatric emergency facility categorization. (2007).


Society of Critical Care Medicine

  • Guidelines and Levels of Care for Pediatric Intensive Care Units. Written in part by the Society of Critical Care Medicine, these guidelines discuss the scope of pediatric critical care services in terms of: (1) organizational and administrative structure, (2) hospital facilities and services, (3) personnel, (4) drugs and equipment, (5) quality monitoring, and (6) training and continuing education. (2004).


EXAMPLE PRACTICES


EMSC State and Territory Program Mandates

The following are examples of state and territorial laws related to EMSC performance measures 74 (The percent of hospitals recognized through a statewide, territorial, or regional standardized system that are able to stabilize and/or manage pediatric medical emergencies) and 75 (The percent of hospitals recognized through a statewide, territorial, or regional standardized system that are able to stabilize and/or manage pediatric trauma emergencies).

Many of these laws were enacted prior to the establishment of the performance measures and may not be an exact match to each performance measure. For example, a law may only apply to the state’s trauma system as opposed to the entire EMS system. Therefore, these examples are meant to be a starting point and not a one-size-fits-all model. Some laws cited below may not be sufficient to achieve the EMSC priorities, but instead may be helpful as examples of how other states regulate EMSC activities.


Florida Department of Health: Trauma Center Standards

The Florida Department of Health has developed a pamphlet that outlines the standards for trauma center across the state. The contents of this pamphlet are “based in part on the standards published in the 1998 version of this pamphlet, in part on the guidelines published in the American College of Surgeons’ Resources for Optimal Care of the Injured Patient: (2006), and in part on the experience gained during site surveys conducted at Florida trauma center applicant hospitals since 1990.”

The pamphlet is broken into chapters that define standard trauma system terms, the standards for Level I & Level II trauma centers, and standards for pediatric trauma centers. (January 2010).


Illinois EMSC Facility Recognition Program

Since 1998, more than 100 Illinois hospitals (including two in Iowa) have received recognition by the Illinois Department of Public Health and the EMSC Program through the Illinois EMSC Facility Recognition initiative. This voluntary program serves to identify the readiness and capabilities of healthcare facilities and staff for providing optimal pediatric emergency and critical care.

Hospitals with enhanced pediatric emergency care resources and abilities can apply for one of three levels of voluntary recognition:

  1. Facilities with pediatric intensive care units that can provide specialty inpatient pediatric services can seek designation as a Pediatric Critical Care Center (PCCC);

  2. Hospitals that can provide comprehensive emergency services and meet pediatric emergency care requirements can be recognized as Emergency Departments Approved for Pediatrics (EDAP); and

  3. Hospitals that can provide pediatric stabilization and have transfer agreements in place when more definitive care is indicated can be categorized as Standby Emergency Departments for Pediatric (SEDP).

According to the Illinois EMSC Program, hospitals seeking one of these voluntary designations receive a site visit by the EMSC program staff to verify that the emergency department and pediatric department are capable of meeting the following key pediatric care standards based on the level being applied for:

  • Professionals specially trained in pediatric emergency and critical care;

  • Adequate staffing and provisions for pediatric consultation and backup;

  • Availability of essential pediatric equipment, supplies and medication;

  • Protocols for the treatment of critically ill and injured children, and protocols to assist in the transfer process;

  • Conduction of pediatric quality improvement activities.

Finally, the Illinois EMSC Facility Recognition web page also includes links to a variety of resources relevant to facility categorization. These include: a list of recognized hospitals, a list of requirements for each level of categorization, a slide presentation reviewing the Facility Recognition Program, and a link to the contents of an AAP/ACEP pediatric toolkit CD-ROM containing information on the resources, equipment, and staffing needed to ensure that hospitals are adequately prepared for pediatric emergencies. (Accessed November 2011).

For additional information about the Illinois Facility Recognition program, see “A Statewide Model Program to Improve Emergency Department Readiness for Pediatric Care,” published in the Annuals of Emergency Medicine, Vol 54, Issue 2, pp 198-204, August 2009.


Oklahoma EMSC Program

Oklahoma initiated EMSC State Partnership performance measures 74 and 75 by utilizing the statewide Trauma Advisory Committee established by the Governor’s Task Force. Research findings from a 1992 Oklahoma EMSC research project on pediatric equipment availability and gaps in emergency medical care helped provide the committee with evidence needed to encourage inclusion of pediatrics within the state’s existing trauma system.

To establish the guidelines for pediatric categorization/recognition, Oklahoma EMSC then utilized the Emergency Department Approved for Pediatrics (EDAP) standards and the American College of Surgeons (ACS) standards for Level 1, II, III, and IV trauma centers. The state Department of Health added strength to the process by developing mandates requiring that that all facilities with emergency departments be categorized at one of the four ACS levels. As a result of these collaborative efforts, pediatrics was ultimately included in the state’s rules and regulations on facility categorization.

For information about Oklahoma’s process toward establishing a facility categorization program, see the EMSC NRC publication Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures.


Tennessee Department of Health

Through its Board for Licensing Healthcare Facilities, Tennessee’s Department of Health has official Rules and Regulations establishing mandatory Standards for Pediatric Emergency Care Facilities. These statewide criteria define the characteristics of hospitals licensed to provide pediatric emergency care, addressing minimum requirements for pediatric regional networking, interfacility transfer agreements, equipment, staffing and resources, education and training, quality monitoring and improvement, and standards of care protocols among other pertinent topics.

Tennessee standards further classify pediatric emergency care facilities into four separate categories based on their ability to provide emergency medical services to children as described below:

  1. Comprehensive regional pediatric healthcare facilities provide comprehensive specialized pediatric medical and surgical care to acutely ill or injured children and serve as regional referral centers.

  2. General pediatric healthcare facilities have separate inpatient pediatric services and departments of pediatrics within their medical infrastructure.

  3. Primary pediatric healthcare facilities provide basic services, have limited capabilities for the management of minor pediatric inpatient problems, and may accept appropriate regional pediatric transfers only when more specialized care center are unavailable.

  4. Basic pediatric healthcare facilities identify, stabilize, and transfer critically ill or injured children. (Accessed November 2011).


FAMILY AND CAREGIVER RESOURCES


EMSC National Resource Center

  • Getting Started, Staying Involved: An EMSC Toolkit for Family Representatives. This EMSC NRC publication, developed for parents and caregivers interested in EMSC, includes sections addressing the importance of hospital recognition for pediatrics. It also contains advice for families on how to work with state EMSC Advisory Committees to develop standardized systems for categorizing facilities based on their ability to stabilize and/or manage pediatric medical and traumatic emergencies. (2008).


American Academy of Pediatrics

  • When Your Child Needs Emergency Medical Services. This tip sheet for families and caregivers provides information on how to react to pediatric healthcare emergencies, including what to bring to the emergency department, and how to communicate with emergency care providers. (Accessed November 2011).

  • What is a Pediatric/Neonatal Critical Care Transport Team? Developed by the AAP’s Section on Transportation Medicine, this document provides explanation on the need for and composition of pediatric-specific transport teams. (2004).


American College of Emergency Physicians

  • Emergency Care of Children. This fact sheet answers questions that parents may have about emergency care for children, such as:

    • Which local emergency department is best for your child?

    • What role do pediatric emergency specialists play in the care of your child?

    • What are emergency physicians doing to improve the care of children?

    • How do you make sure your child gets appropriate treatment in an emergency? (Accessed November 2011).