Are children unsupervised in your ED? Know the risks

You could be at risk for a lawsuit

A baby girl is unhurt in a motor vehicle accident, but her mother needs X-rays. An unconscious man is about to be admitted, and his two small children tell you that all their family members live out of state.

Both cases result in unattended children spending time in your ED. It’s a frustrating problem, but you may not realize that this also is legally risky, warns Stephen A. Frew, JD, vice president and risk consultant with Johnson Insurance Services, a Madison, WI-based company specializing in risk management for health care professionals.

"Unless there are dedicated personnel assigned to watching children, I recommend against separating the parents and children except in serious injury cases," he advises. In those cases, social services personnel should be contacted to come to the ED to provide supervision and make efforts to secure family care or other protective services, says Frew.

"Separating the children from the parent typically results in more problems and disruptions than tolerating the children in the treatment area, unless family members are available to watch the child or children in the waiting area," says Frew.

EDs should have policies and protocols that assign responsibility to specific staff members to follow up on family contacts, advises Frew.

At Gwinnett Medical Center in Lawrenceville, GA, if the patient is in the ED being treated and child care is needed for a short period of time, an ED technician is assigned to care for that child, says Denise Proto, RN, MS, CEN, nurse educator for emergency services. However, if the patient needs admission, the ED nurse contacts social services to make arrangements if necessary, says Proto.

"Of course, our optimal hope would be that a family member would be contacted. But if not, other arrangements — including possible intervention from the Department of Children and Family Services — would take place," she says.

Whenever possible, children are kept with their parent, and family members are contacted as needed, says Kathy Hendershot, RN, director of clinical operations for the ED at Clarian Health Partners in Indianapolis. "We are very fortunate to have child-life specialists for 12 hours a day from the pediatric area," she says. "They have been very supportive when called to help watch children until we can get someone else in here."

Social workers, chaplains, and secretarial staff are other possibilities, depending on the situation, says Hendershot. "We get very creative," she says. "I have had children in my office until we can get help."

Providing entertainment such as videotapes and an enclosed play area can be helpful, but are not a substitute for adult supervision, notes Frew. "State laws may vary on what constitutes a child care facility," he says. "Also, safety and infection control must be considered for any toys provided."

Staff supervision needed

Even when the children are with the parent, some degree of staff supervision may be required for safety reasons and also to ensure that treatment of the patient isn’t hindered, says Frew.

He points to a lawsuit involving a 3-year-old boy who ran around an ED unsupervised, collided with a treatment table, and ended up with a gash on his forehead. "The child was promptly and effectively treated, but the mother filed a claim on a theory of malpractice by the nurse in failing to contain the patient’s child," says Frew. The matter was denied as a malpractice claim by the professional liability insurer and settled for a waiver of the child’s bill and parent’s copay through the general liability carrier, reports Frew.

"This type of case is often handled through the risk management department without ever involving an insurer, but points out that hospitals are potentially dangerous places for unsupervised children," he says.

An ED may be potentially liable for failing to protect a child if staff are aware of a risk, says Frew. "Obviously allowing a child to handle dangerous instruments, hang on equipment that might fall over, or ingest drugs awaiting use would represent serious risk of suit if the nurse were aware of the risk and fails to act," he says.

Sources

For more information on unsupervised children in the ED, contact:

  • Stephen A. Frew, JD, Vice President-Risk Consultant, Johnson Insurance Services, 525 Junction Road, Suite 2000, Madison, WI 53717. Telephone: (608) 245-6560. Fax: (608) 245-6585. E-mail: sfrew@johnsonins.com.
  • Kathy Hendershot, RN, MSN, CS, Director, Clinical Operations, Emergency Medicine and Trauma Center, Methodist Hospital, I-65 at 21st St., P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-8939. Fax: (317) 962-2306. E-mail: KHendershot@clarian.org.
  • Denise Proto, RN, MS, CEN, Nurse Educator, Emergency Services, Gwinnett Medical Center, 1000 Medical Center Blvd., Lawrenceville, GA 30045. Telephone: (678) 442-4414. E-mail: DProto@ghsnet.org.