American parents expect the treatment their children receive - whether it's at school, day care or at the hospital - to be the best, most compassionate care. Unfortunately, the majority of doctors working in emergency care units have had only minimal experience, an average of four months, working with children. Medical malpractice attorneys at Pintas & Mullins further explain this problem and how American children are suffering the consequences.
Children are three times more likely to suffer a serious medication error than adults. Clinically, children are not just 'little adults.' Their metabolic rates are completely different, so medications dissolve at faster rates. Children often have undiagnosed allergies, and doses need to be adjusted for weight and other factors.
To help combat this, some hospitals are hiring staffs of full-time pharmacists in the ER to reduce medication errors and adverse events. Medication errors contribute to approximately 7,000 deaths in the country every year, and are particularly dangerous in children. The Children's Medical Center in Dallas, for example, was recently profiled on NPR for hiring ten new 24-hour pharmacists who specialize in emergency medicine.
The overriding issue, however, is that emergency room doctors are often young with little experience. Millions of children visit the ER each year, however, only one in ten children are able to see doctors with any real experience in pediatrics. The remaining 90% of kids are treated in general ERs, such as at community hospitals, where just four months of training in pediatrics is required.
Statistically, about 30% of ER patients are children; however, the education doctors receive in pediatrics represents less than 10% of their training. In 2006, the Institute of Medicine released a report titled "Emergency Care for Children: Growing Pains." In this report, the Institute describes the unique challenges facing emergency departments in their treatment of children.
Researchers involved in this project found that many general ER physicians feel much more stress and anxiety when caring for pediatric patients compared to adults. Too often, this causes doctors to under-treat and fail to stabilize children who are critically ill. Unlike adult patients, there are no established patterns for treating children in the ER, which leads to a wide array of treatments that may not always work.
Fortunately, there are concerted efforts throughout the country aimed at fixing this problem. One of these programs, Improving Pediatric Acute Care Through Simulation (ImPACTS), conducted 200 fake pediatric emergencies in 25 emergency departments, the majority of which were in community hospitals. Their findings were alarming to say the least.
Among treatments for pediatric septic shock, only 13% of general emergency departments were compliant with treatment guidelines for children - compared to over 93% of pediatric EDs that were in full compliance. Community hospitals also showed severed deficiency in delivering life-saving fluids and blood pressure medications to children, and were much less likely to administer correct doses of other drugs or comply with other pediatric guidelines for life-threatening conditions, such as cardiac arrest.
So what can be done? Experts agree that doctors need to receive more education regarding pediatric emergency care in their formal training, including mandatory continued education for emergency medicine residents targeted specifically toward pediatrics. There has also been immense effort put into incorporating functioning partnerships between community hospitals and children's hospitals. Collaborations of this kind will allow constant information exchanges, including educational forums, emergency consultations, and opportunities for continued pediatric emergency medicine.