Most commonly, a pediatric patient refers to either a child or adolescent under 16 or 18 years of age. However, especially in the United States, someone under the age of 21 is also defined as a pediatric patient (i.e. Rutherford et al. 2010).
In this study, pediatric patients are considered children and adolescents under 16 years of age, according to the Finnish Health Care Act definition (Health Care Act 1326/2010).
Pediatric patients are a significant part of the users of emergency services. In
age (McDermott et al. 2018). In addition, in Italy, the prevalence of children under the age of 18 visiting the ED at least once is analyzed as being nearly 27% (Riva et al. 2018). In England and Italy, Poropat et al. (2017) found that children’s reasons for ED attendance were similar in both countries, and the main ED patients were children under the age of one. Also, fever, breathing difficulties, gastrointestinal problems, and trauma were the most represented reasons for children’s ED attendance. (Poropat et al. 2017.)
2.2.1 Pediatric emergency care organization
In Finland, the municipalities or hospital districts organize emergency care, and 24-hour primary health care emergency service is organized in cooperation with specialized health care, hereby referred to as a joint ED. Twelve hospitals, five university hospitals, and seven central hospitals provide an extensive 24-hour emergency service. These are all joint emergency services, including social emergency amenities. Finland’s Ministry of Social Affairs and Health (STM) is responsible for the general planning, steering, and monitoring of specialized care (Health Care Act 1326/2010). Pediatric emergency care is settled either as a part of joint general emergency services in university hospitals or dedicated PEDs in university hospitals (STM 2017).
Globally and in Finland, the method as to how pediatric emergency care is organized differs (STM 2017; IOM 2007). There are two types of organizations of care: mixed general EDs for children and adults and pediatric emergency departments (PEDs) for children and adolescents only (e.g. Hudgings et al.
2017; Peeler et al. 2016). Finland’s Ministry of Social Affairs and Health (2017) emphasized that, in emergency services, pediatric patients and families will benefit from well-designed facilities, a safe environment, and experienced pediatric staff (STM 2017).
Pediatric patients differ from adult ED patients based on physical and emotional needs. Children need equipment to fit their specific sizes, medication calculated for specific doses, and trained staff for pediatric care (IOM 2007).
Therefore, in the United States, the ENA has set a specific guideline for the care of children in EDs (ENA 2013). This guideline emphasizes how vital it is for EDs to be prepared to care for children of all ages with appropriate resources:
facilities, equipment, policies, education, and staff (ENA 2013). Globally, the World Health Organization (WHO 2018) has developed “Standards for improving the quality of care for children and young adolescents in health facilities” (WHO 2018). This is a comprehensive description of the ways and principles according to how pediatric patients should be treated in health care. The WHO principles emphasize the child as an individual in both care and facilities and as an active actor in care, as well as his/her right to quality care and support.
2.2.2 Elements of pediatric emergency care
The pediatric emergency care process consists of the child’s triage assessment, examinations and care, and discharge or admission to a hospital (Rutherford et al. 2010; Green et al. 2012; Ortiz et al. 2012; Doyle et al. 2012). The pediatric patients’ care process begins with patient triage assessments. The main purpose of the protocol is to differentiate patients who need life-saving care from those who can wait (Green et al. 2012; WHO 2018). The other purpose is related to ED functionality when dividing patients into different ED areas and/or teams according to the acuity of care track, such as the fast track (i.e. Doyle et al. 2012). Pediatric triage systems that are globally used are Emergency Severity Index (ESI), Manchester Triage Scale (MTS), and Canadian Triage Scale (CTAS) (Green et al. 2012; Gravel et al. 2013; De Magalhães-Barbosa et al. 2017). These are five-category assessment scales with individual criteria: ESI is based on patients’ acuity and ED resource needs, and MTS and CTAS are based on patients’ acuity. Finland has also used the five-level ABCDE triage, which is based on patients' acuity (Kantonen et al. 2010). Finland’s Ministry of Social Affairs and Health (2017) has stated that triage assessment from a pediatric nurse is more appropriate than from a general emergency nurse, which is why large pediatric emergency services should have pediatric nursing staff. (STM 2017.)
According to a Mexican study (Ortiz et al. 2012), a child undergoes
approximately two diagnostic or care-related procedures during his/her ED visit.
Children often experience these situations as painful or stressful, and therefore pain and stress relief are an important part of pediatric emergency care (Ortiz et al. 2012). According to the literature review (Wente 2013),
non-pharmacological pain treatment is a protocol used in pediatric nursing in EDs, and it relieves children’s pain and anxiety. Techniques included a distraction, parental holding/positioning, cold treatment, and the use of sucrose (Wente 2013).
Pediatric care in the ED involves the child’s parent or guardian. Hemingway and Redsell (2011) addressed challenges in communication between ED professionals and children and parents. Challenges were related to the ED environment, time limitations, and the child’s level of sickness (Hemingway &
Redsell 2011). However, communication between children and nurses during emergency care, including asking for and following children’s suggestions related to care, has been found to increase the child’s and family’s experience of safety and to strengthen their involvement in care (Grahn et al. 2017).
Overall, in pediatric emergency care, it is recommended to conduct family-centered care (FCC) (ENA 2013; IOM 2006).
When emergency care is completed, discharge guidance is essential from the perspective of safety and quality of care as well as from the perspective of the number of ED revisits. There is a possibility to teach patients and families about the proper use of the ED and where to seek care for children if needed.
(Gozdzialski et al. 2012.)