Develop clear policies for pediatric transfers

Do you know which sick and injured children should be transferred to specialized facilities? Do you know the appropriate type of transport to use and which staff members should accompany the child?

You should have a specific policy in place for these nerve-wracking scenarios, according to new guidelines for pediatric care, Care of Children in the Emergency Department: Guidelines for Preparedness, jointly published by the Dallas-based American College of Emergency Physicians (ACEP) and the Elk Grove Village, IL-based American Academy of Pediatrics (AAP).

When a pediatric patient is seriously ill or injured, having a clear transfer policy in place can potentially save the child’s life, says Evelyn Lyons, RN, MPH, EMS-C director for the Illinois Department of Public Health, based at Loyola University Medical Center in Maywood, IL.

"Every ED should develop appropriate guidelines, policies, and procedures for obtaining consultation and arranging transport," she asserts. "This will help to minimize delays." (See Sample Pediatric Transfer Policy, in this issue.) Your policy should include:

Criteria for transfer.

Your policy should include specific criteria for admission to the pediatric unit, admission to the pediatric intensive care unit, and transfer to a pediatric center, recommends Barbara Weintraub, RN, MPH, MSN, pediatric emergency services coordinator at Northwest Community Hospital in Arlington Heights, IL.

Procedure for consultations with specialists.

Consultation with pediatric medical and surgical specialists at a pediatric tertiary care center or trauma specialists at a trauma center should occur as soon as possible after evaluation of the patient, says Lyons.

• Identification of referral centers.

Your policy should identify facilities that provide specialized pediatric critical care or trauma services, says Lyons.

These specialized referral centers provide 24-hour telephone consultation to assist you in the evaluation and management of critically ill and injured children, says Lyons.

"In addition, most of these referral centers provide pediatric interfacility transport services to facilitate the transport of critically ill or injured children to specialized centers when indicated," she notes.

Arrangements for children with special needs.

You should have specific protocols for transferring patients with special needs, including spinal cord injuries and burns, says Weintraub.

Emergency Medical Treatment and Active Labor Act (EMTALA) compliance.

As the transferring facility, you must ensure that the patient is stabilized before transport, says Lyons. To comply with EMTALA, you must transfer only patients who need a higher level of care, she cautions.

Method of transportation.

Your policy needs to address the way patients will be transported, says Weintraub. This should be based on the patient’s needs, your location, your destination, weather considerations, and the availability of various transport modalities in your area, such as helicopter vs. ground transport, she adds. "This ensures a smooth transfer from your facility to a higher level of care," she emphasizes.

Sources and Resources

For more information about pediatric transfer policies, contact:

Evelyn Lyons, RN, MPH, EMSC Director, Loyola University Medical Center, 2160 S. First Ave., Building 110, Room 0244, Maywood, IL 60153. Telephone: (708) 327-2556. Fax: (708) 327-2548. E-mail: elyons@luc.edu.

Barbara Weintraub, RN, MPH, MSN, Northwest Community Hospital, 800 W. Central Road, Arlington Heights, IL 60005. Telephone: (847) 618-5432. Fax: (847) 618-4169. E-mail: bweintraub@nch.org.

A copy of the policy statement, "Care of Children in the Emergency Department: Guidelines for Preparedness" (published in the April 2001 issue of Pediatrics Annals of Emergency Medicine) can be and downloaded free from the web site: www.aap.org. (Click on "Policy Statements." Under heading "C," click on "Care of children in the emergency department: Guidelines for preparedness.")