Pediatric emergency medicine physicians are at greater risk for malpractice claims than general pediatricians and nonhospital-based pediatric subspecialties, according to the authors of a recent analysis of survey results gathered between 1987 and 2015.1 “The ED [emergency department] is a 24-hour, fast-paced environment with rapidly changing acuity, no prior physician-patient relationship, and patients who often can’t verbalize their symptoms,” says Jonathan M. Fanaroff, MD, JD, FAAP, one of the study’s authors.

Each of those factors contributes to the higher malpractice risk identified in the study. “ED providers may feel that a lawsuit won’t happen to them, when in fact lawsuits related to ED care are common,” says Fanaroff, a professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland. Staying current, good documentation, and communicating effectively, not only with other healthcare providers but also the patient and family, alleviate legal risks.

“Additionally, not locking into a diagnosis too soon to the exclusion of other potential diagnoses can help decrease the risk of a diagnostic error,” Fanaroff adds.

It is important to note that general EDs are, in fact, qualified to take care of children, says Michael J. Gerardi, MD, FAAP, FACEP, director of pediatric emergency medicine services for Atlantic Health at the Goryeb Children’s Hospital in Morristown, NJ. The vast majority of children are, in fact, cared for in general EDs, which care for both adults and children.2,3 Gerardi says these practices can help general EDs defend against malpractice litigation — or prevent it in the first place:

Designate a champion (ideally, on both the nursing and physician side) who ensures all appropriate pediatric equipment and protocols are in place. “Every ED really needs a champion for children to keep abreast of the latest developments in pediatric emergency medicine,” Gerardi says. “If you don’t have that, you’re opening yourself up for liability.”

For instance, the champions can consult with emergency physicians (EPs) facing tough calls on whether to transfer a child with abdominal pain or acute pneumonia or bronchiolitis.

Put transfer agreements in place ahead of time (and staff who are familiar with them). “It’s a simple phone call to get a pediatric patient to a tertiary center, if that’s what they require,” Gerardi says.

Document exactly what is discussed with consultants. “Once a bad event happens, you can’t add the discussion to the chart. It then becomes a ‘he said/she said’ situation,” Gerardi notes. These kinds of specifics can be essential to the defense team: “Talked to GI specialist. Due to the fact that bicarbonate level was low, have decided to transfer.” “Kid is smiling, blowing bubbles, and playing with my iPad. Decided to discharge with f/u tomorrow, as discussed with peds GI.” “Peds hospitalist examined the child again. We all agreed child can go home.”

“That’s a bulletproof chart,” Gerardi says. “And what does it take you — two minutes?”


  1. Bondi SA, Tang SS, Altman RL, et al. Trends in pediatric malpractice claims 1987-2015: Results from the periodic survey of fellows. Pediatrics 2020;145:e20190711.
  2. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project. Statistical Brief #242. Overview of pediatric emergency department visits, 2015. August 2018.
  3. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Committee; Emergency Nurses Association, Pediatric Committee. Joint policy statement: Guidelines for care of children in the emergency department. J Emerg Nurs 2013;39:116-131.