Illinois Emergency Medical Services for Children (EMSC)

Facility Recognition Criteria For The Emergency Department Approved for Pediatrics (EDAP)

1. Professional Staff: Physicians

1.1 Qualifications

1. Twenty-four hour coverage of the emergency department shall be provided by at least one physician responsible for the care of critically ill or injured children as evidenced by one of the following:

A. certification in Emergency Medicine by the American Board of Emergency Medicine (ABEM) or American Osteopathic Board of Emergency Medicine (AOBEM) or residency-trained/board- eligible in Emergency Medicine and in the first cycle of the board certification process;

B. certification in Pediatric Emergency Medicine by the American Board of Pediatrics/ABEM (ABP/ABEM) or residency-trained/board-eligible in pediatric emergency medicine and in the first cycle of the board certification process;

C. certification in one of the following boards and current American Heart Association (AHA)/American Academy of Pediatrics (AAP) Pediatric Advanced Life Support (PALS) recognition or American College of Emergency Physicians (ACEP)/AAP Advanced Pediatric Life Support (APLS) or equivalent course:

• family practice by the American Board of Family Practice (ABFP) or American Osteopathic Board of Family Practice (AOBFP);

• certification in pediatrics by the ABP or American Osteopathic Board of Pediatrics (AOBP);

• residency-trained/board-eligible in either family practice or pediatrics and in the first cycle of the board-certification process;

D. a physician who has received a waiver from the Illinois Department of Public Health based on meeting one of the criteria below:

• an emergency department physician who already has received a waiver per the Trauma Center Rules & Regulations (Section 515.2030, e 1 B; Section 515.2040, f 1 B);

• completion of 12 months of internship followed by at least 7,000 hours of hospital-based emergency medicine that includes pediatric patients over the last 60-month period (including 2,800 hours within one 24-month period), verified in writing by the hospital(s) at which the internship and subsequent hours were completed and current AHA-AAP PALS or ACEP-AAP APLS recognition;

• completion of professional activities spent in the practice of pediatric emergency medicine (PEM), over the last 60-month period and totaling a minimum of 6,000 hours, clearly focused in the care of patients in the pediatric age group (< 21 years of age) in the emergency department and demonstrated by the following:

1) Of the 6,000 hours, 2,800 hours must have been accrued in a 24-month (maximum) consecutive period of time;

2) A minimum of 4,000 of the 6,000 hours must have been spent in the clinical practice of PEM. (If practiced in a general ED, only time spent exclusively in pediatric practice can be used for credit);

3) The remaining 2,000 hours may be spent in either clinical care or a mixture of related nonclinical activities clearly focused on PEM including administration, teaching, pre- hospital care, quality improvement, research, or other academic activities.

1.2 Continuing Medical Education

All full- or part-time emergency physicians shall have documentation of a minimum of 16 hours of continuing medical education (American Medical Association [AMA] Category I or II) in pediatric emergency topics within a two-year period.

1.3 Coverage

At least one physician satisfying 1.1 shall be on duty in the emergency department 24 hours a day.

1.4 Consultation

Telephone consultation with a physician who is board-certified or eligible in pediatrics or pediatric emergency medicine shall be available 24 hours a day. Consultation can be with an on-staff physician or in accordance with the Illinois EMSC Interfacility Pediatric Trauma and Critical Care Consultation and/or Transfer Guideline.

1.5 Physician Backup

A "backup" physician whose qualifications and training are equivalent to that of 1.1 shall be available to the EDAP within one hour to assist with critical situations or disasters.

1.6 On-Call Physicians

Protocols shall be available that address maximum response time for on-call physicians.

2. Professional Staff: Mid-Level Providers. (Mid-level provider is defined as a nurse practitioner or physician assistant who works under the supervision of a licensed physician who satisfies criteria 1.1a and 1.1b.)

2.1 Qualifications

A. Nurse practitioners shall have:

1. completed a pediatric nurse practitioner program or emergency nurse practitioner program or family practice nurse practitioner program;

2. an Illinois advanced practice license within one year of hire;

3. credentialing that reflects orientation, ongoing training, and specific competencies in the care of the pediatric emergency patient.

B. Physician assistants shall have:

1. current Illinois licensure (permanent or temporary);

2. credentialing that reflects orientation, ongoing training, and specific competencies in the care of the pediatric emergency patient.

C. All nurse practitioners and physician assistants shall successfully complete and maintain current recognition in one of the following courses: the AHA-AAP PALS Course, the ACEP-AAP APLS Course, or the Emergency Nurses Association (ENA) Emergency Nursing Pediatric Course (ENPC).

2.2 Continuing Medical Education

A. All full- or part-time nurse practitioners shall have documentation of a minimum of 16 hours of approved continuing education units (CEUs) in pediatric emergency topics within a two-year period.

B. All full- or part-time physician assistants shall have documentation of a minimum of 16 hours of continuing medical education (AMA Category I) in pediatric emergency topics within a two- year period. Credit for CME must be approved by the Accreditation Council on Continuing Medical Education (ACCME), American Osteopathic Association Council on Continuing Medical Education (AOCCME), American Academy of Family Physicians (AAFP), or American Academy of Physician Assistants (AAPA).

3. Professional Staff: Nursing

3.1 Qualifications

A. At least one RN on duty each shift who is responsible for the direct care of the child in the emergency department shall successfully complete and maintain current recognition in one of the following courses in pediatric emergency care.

• AHA-AAP PALS provider course;

• ACEP-AAP APLS provider course;

• ENA ENPC.

B. All emergency department nurses shall successfully complete and maintain current recognition in one of the above educational requirements within 24 months of employment.

3.2 Continuing Education

All nurses assigned to the emergency department shall have documentation of a minimum of eight hours of pediatric emergency/critical care continuing education hours within a two-year period. Continuing education may include, but is not limited to CEU offerings, case presentations, competency testing, teaching courses related to pediatrics and/or publications. These continuing education hours can be integrated with other existing continuing education requirements, provided that the content is pediatric-specific.

4. Policies and Procedures

4.1 Interfacility Transfer

Transfer agreement(s) with emergency pediatric centers (EPCs) and policies/procedures concerning transfer of critically ill and injured patients to EPCs. Incorporating the components of the Illinois EMSC Interfacility Pediatric Trauma and Critical Care Consultation and/or Transfer Guideline into the emergency department transfer policy/procedure will meet this requirement.

4.2 Suspected Child Abuse

Policies/procedures addressing the identification, evaluation, treatment, and referral of victims of suspected child abuse in accordance with state mandates.

4.3 Treatment Protocols

Protocols addressing appropriate stabilization measures in response to critically ill or injured pediatric patients (i.e., trauma, respiratory distress, seizures).

4.4 Latex-Free Policy

Policy addressing availability of latex-free equipment and supplies.

5. Quality Improvement

5.1 Multidisciplinary Committee

Pediatric emergency medical care shall be included in the EDAP’s emergency department or section quality improvement (QI) program and reported to the hospital QI committee.

Multidisciplinary continuous QI (CQI) activities shall be established with documented CQI monitors addressing pediatric care within the emergency department with identified clinical indicators and/or outcomes for care. These activities shall include children from birth up to and including 16 years of age and shall consist of, but are not limited to, all pediatric emergency department deaths, resuscitations, and interfacility transfers.

5.2 Pediatric CQI Liaison

A member of the professional staff who has ongoing involvement in the care of pediatric patients shall be designated and supported by the hospital as the pediatric liaison. This individual may be employed in an area other than the emergency department and shall have a minimum of two years of pediatric critical care or emergency department experience.

The responsibilities of the pediatric liaison shall include:

5.2.1 — ensure and document pediatric continuing education of all emergency department professional staff (Criteria 1.1, 1.2, 2.1, 2.2, 3.1 and 3.2);

5.2.2 — maintain a data summary and work in conjunction with the multidisciplinary CQI committee to coordinate criteria-based review and follow-up of sample pediatric emergency department visits (Criteria 5.1);

5.2.3 — coordinate review of pre-hospital provider transported pediatric cases and provide feedback to the emergency medical services (EMS) system coordinator and the EMS Regional Advisory Board.

5.2.4 — a written CQI report and attendance at the EMS Regional CQI subcommittee shall be supported by the hospital. One representative from the CQI subcommittee shall report to the EMS Regional Advisory Board.

5.2.5 — CQI information shall be made available to the Illinois Department of Public Health upon request.

Source: Illinois Department of Public Health, Springfield, IL. Excerpt from Facility Recognition Application Packet.