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Policy Statement: Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children| Volume 48, ISSUE 6, P652-665, November 01, 2022

Optimizing Pediatric Patient Safety in the Emergency Care Setting

Published:October 05, 2022DOI:https://doi.org/10.1016/j.jen.2022.08.010

      Abstract

      This is a revision of the previous American Academy of Pediatrics policy statement titled “Patient Safety in the Emergency Care Setting” and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergency care setting. Caring for children in the emergency setting can be prone to medical errors because of a number of environmental and human factors. The emergency department has frequent workflow interruptions, multiple care transitions, and barriers to effective communication. In addition, the high volume of patients, high decision density under time pressure, diagnostic uncertainty, and limited knowledge of patients’ history and preexisting conditions make the safe care of critically ill and injured patients even more challenging. It is critical that all emergency departments, including general emergency departments who care for the majority of ill and injured children, understand the unique safety issues related to children. Furthermore, it is imperative that all emergency departments practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This policy statement outlines the recommendations necessary for emergency departments to minimize pediatric medical errors and to provide safe care for children of all ages.

      Abbreviations:

      AAP (American Academy of Pediatrics), ACEP (American College of Emergency Physicians), AI (artificial intelligence), CDS (clinical decision support), CPOE (computerized physician order entry), ED (emergency department), EHR (electronic health record), ENA (Emergency Nurses Association), EMS (Emergency Medical Services)
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      References

        • Institute of Medicine, Committee on Quality of Health Care in America
        To Err Is Human: Building a Safer Health Care System. 2000; (Kohn LT, Corrigan JM, Donaldson MS, eds. Washington, DC: National Academies Press; 2000)
        • Walsh K.E.
        • Bundy D.G.
        • Landrigan C.P.
        Preventing health care-associated harm in children.
        JAMA. 2014; 311: 1731-1732
        • Alghamdi A.A.
        • Keers R.N.
        • Sutherland A.
        • et al.
        Prevalence and nature of medication errors and preventable adverse drug events in pediatric and neonatal intensive care settings: a systematic review.
        Drug Saf. 2019; 42: 1423-1436
        • Krug S.E.
        • Frush K.
        American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. Patient safety in the pediatric emergency care setting.
        Pediatrics. 2007; 120 (Reaffirmed June 2011 and July 2014): 1367-1375
        • Remick K.
        • Gausche-Hill M.
        • Joseph M.M.
        • et al.
        American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, Section on Surgery; American College of Emergency Physicians, Pediatric Emergency Medicine Committee; Emergency Nurses Association, Pediatric Committee. Pediatric readiness in the emergency department.
        Pediatrics. 2018; 142e20182459
        • American Academy of Pediatrics
        Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Emergency Medicine Committee; Emergency Nurses Association, Pediatric Committee. Handoffs: transitions of care for children in the emergency department.
        Pediatrics. 2016; 138e20162680
        • Dudley N.
        • Ackerman A.
        • Brown K.
        • Snow S.
        American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Emergency Medicine Committee; Emergency Nurses Association, Pediatric Committee. Technical report. Patient- and family-centered care of children in the emergency department.
        Pediatrics. 2015; 135: e255
        • Benjamin L.
        • Frush K.
        • Shaw K.
        • et al.
        American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Emergency Medicine Committee; Emergency Nurses Association, Pediatric Emergency Medicine Committee. Pediatric medication safety in the emergency department.
        Pediatrics. 2018; 141e20174066
        • Mueller B.U.
        • Neuspiel D.R.
        • Fisher E.R.S.
        American Academy of Pediatrics, Council on Quality Improvement and Patient Safety. Principles of pediatric patient safety: reducing harm due to medical care.
        Pediatrics. 2019; 143e20183649
        • Chassin M.R.
        • Loeb J.M.
        High-reliability health care: getting there from here.
        Milbank Q. 2013; 91: 459-490
        • Frankel A.
        • Haraden C.
        • Federico F.
        Lenoci-Edwards J..
        A Framework for Safe, Reliable, and Effective Care. White Paper. 2017; (Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017)
        • Shaw K.N.
        • Ruddy R.M.
        • Olsen C.S.
        • et al.
        Pediatric patient safety in emergency departments: unit characteristics and staff perceptions.
        Pediatrics. 2009; 124: 485-493
        • Tourani S.
        • Hassani M.
        • Ayoubain A.
        • et al.
        Analyzing and prioritizing the dimensions of patient safety culture in emergency wards using the TOPSIS technique.
        Glob J Health Sci. 2015; 7: 143-150
        • Vebeek-Van Noord I.
        • Wagner C.
        • Van Dyck C.
        • et al.
        Is culture associated with patient safety in the emergency department? A study of staff perspectives.
        Int J Qual Health Care. 2014; 26: 64-70
        • Byczkowski T.L.
        • Gillespie G.L.
        • Kennebeck S.S.
        • et al.
        Family-centered pediatric emergency care: a framework for measuring what parents want and value.
        Acad Pediatr. 2016; 16: 327-335
        • Vanhoy M.A.
        • Horigan A.
        • Stapleton S.J.
        • et al.
        • Emergency Nurses Association, Clinical Practice Guideline Committee
        Clinical practice guideline: family presence.
        J Emerg Nurs. 2019; 45: 76.e1-76.e29https://doi.org/10.1016/j.jen.2018.11.012
        • Zavotsky K.E.
        • McCoy J.
        • Bell
        • et al.
        Resuscitation team perceptions of family presence during CPR.
        Adv Emerg Nurs J. 2014; 36: 325-334
        • Nicholas D.B.
        • Muskat B.
        • Zwaigenbaum L.
        • et al.
        Patient and family-centered care in the emergency department for children with autism.
        Pediatrics. 2020; 145e20191895
        • Hall J.E.
        • Patel D.P.
        • Thomas J.W.
        • Richards C.A.
        • Rogers P.E.
        • Pruitt C.M.
        Certified child life specialists lessen emotional distress of children undergoing laceration repair in the emergency department.
        Pediatr Emerg Care. 2018; 34: 603-606
        • Sanchez Cristal N.
        • Staab J.
        • Chatham R.
        • Ryan S.
        • Mcnair B.
        • Grubenhoff J.A.
        Child life reduces distress and pain and improves family satisfaction in the pediatric emergency department.
        Clin Pediatr (Phila). 2018; 57: 1567-1575
        • Koller D.
        Child Life Council. Evidence-Based Practice Statement Summary: Preparing Children and Adolescents for Medical Procedures.
        Date accessed: May 28, 2020
        (Available at: https://www.childlife.org/docs/default-source/research-ebp/ebp-statements.pdf?sfvrsn=6395bd4d_2)
      1. Institute for Patient- and Family-Centered Care. Patient- and Family-Centered Care.
        Date accessed: January 20, 2022
        (Available at: https://www.ipfcc.org/about/pfcc.html)
        • Johnson T.J.
        • Weaver M.D.
        • Borrero S.
        • et al.
        Association of race and ethnicity with management of abdominal pain in the emergency department.
        Pediatrics. 2013; 132e851
        • Goyal M.K.
        • Kuppermann N.
        • Cleary S.D.
        • Teach S.J.
        • Chamberlain J.M.
        Racial disparities in pain management of children with appendicitis in emergency departments.
        JAMA Pediatr. 2015; 169: 996-1002
        • Goyal M.K.J.T.
        • Chamberlain J.M.
        • Cook L.
        • et al.
        Pediatric Emergency Care Applied Research Network. Racial and ethnic differences in emergency department pain management of children with fractures.
        Pediatrics. 2020; 145e20193370
        • Marin J.R.
        • Rodean J.
        • Hall M.
        • et al.
        Racial and ethnic differences in emergency department diagnostic imaging at US children’s hospitals, 2016-2019.
        JAMA Netw Open. 2021; 4e2033710
        • Goyal M.
        • Johnson T.J.
        • Chamberlain J.
        • et al.
        Racial and ethnic differences in antibiotic use for viral illness in emergency departments.
        Pediatrics. 2017; 140e20170203
        • Raphael J.L.
        • Oyeku S.O.
        Implicit bias in pediatrics: an emerging focus in health equity research.
        Pediatrics. 2020; 145e20200512
        • FitzGerald C.
        • Hurst S.
        Implicit bias in healthcare professionals: a systematic review.
        BMC Med Ethics. 2017; 18: 19
        • McMichael B.
        • Nickel A.
        • Duffy E.A.
        • et al.
        The impact of health equity coaching on patient's perceptions of cultural competency and communication in a pediatric emergency department: an intervention design.
        J Patient Exp. 2019; 6: 257-264
        • Agency for Healthcare Research and Quality
        Chart Book on Patient Safety. Rockville, MD.
        Date accessed: November 15, 2020
        (Available at: https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/patientsafety/index.html)
        • Johnstone M.J.
        • Kanitsaki O.
        Culture, language, and patient safety: making the link.
        Int J Qual Health Care. 2006; 18: 383-388
        • Flores G.
        • American Academy of Pediatrics, Committee on Pediatric Research
        Technical report—racial and ethnic disparities in the health and health care of children.
        Pediatrics. 2010; 125: e979-e1020
        • Cheraghi-Sohi S.
        • Panagioti M.
        • Daker-White G.
        • et al.
        Patient safety in marginalized groups: a narrative scoping review.
        Int J Equity Health. 2020; 19: 26
        • Goenka P.K.
        Lost in translation: impact of language barriers on children’s healthcare.
        Curr Opin Pediatr. 2016; 28: 659-666
        • Taveras E.M.
        • Flores G.
        Why culture and language matter: the clinical consequences of providing culturally and linguistically appropriate services to children in the emergency department.
        Clin Pediatr Emerg Med. 2004; 5: 76-84
      2. Agency for Healthcare Research and Quality. Chapter 1: Background on Patient Safety and LEP Populations. In: Improving Patient Safety Systems for Patients With Limited English Proficiency. Rockville, MD: Agency for Healthcare Research and Quality; 2012 (last reviewed September 2020).
        Date accessed: January 12, 2022
        (Available at: https://www.ahrq.gov/health-literacy/professional-training/lepguide/chapter1.html)
        • Steinberg E.M.
        • Valenzuela-Araujo D.
        • Zickafoose J.S.
        • Kieffer E.
        • DeCamp L.R.
        The "battle" of managing language barriers in health care.
        Clin Pediatr (Phila). 2016; 55: 1318-1327
        • Mosquera R.A.
        • Samuels C.
        • Flores G.
        Family Language Barriers and Special-Needs Children.
        Pediatrics. 2016; 138e20160321
        • Gallagher R.A.
        • Porter S.
        • Monuteaux M.C.
        • Stack A.M.
        Unscheduled return visits to the emergency department: the impact of language.
        Pediatr Emerg Care. 2013; 29: 579-583
        • Zamor R.
        • Byczkowski T.
        • Zhang Y.
        • et al.
        Language barriers and the management of bronchiolitis in a pediatric emergency department.
        Acad Pediatr. 2020; 20: 356-363
        • Fileccia J.
        Sensitive care for the deaf: a cultural challenge.
        Creat Nurs. 2011; 17: 174-179
        • Institute of Medicine, Committee on Diagnostic Error in Health Care
        Improving Diagnosis in Health Care. 2015; (Balogh EP, Miller BT, Ball JR, eds. Washington, DC: National Academies Press; 2015)
        • Medford-Davis L.N.
        • Singh H.
        • Mahajan P.
        Diagnostic decision-making in the emergency department.
        Pediatr Clin North Am. 2018; 65: 1097-1105
        • Mahajan P.
        • Basu T.
        • Pai C.
        • et al.
        Factors associated with potentially missed diagnosis of appendicitis in the emergency department.
        JAMA Netw Open. 2020; 3e200612
        • Sundberg M.
        • Perron C.O.
        • Kimia A.
        • et al.
        A method to identify pediatric high-risk diagnoses missed in the emergency department.
        Diagnosis (Berl). 2018; 5: 63-69
        • Czolgosz T.
        • Cashen K.
        • Farooqi A.
        • Kannikeswaran N.
        Delayed admissions to the pediatric intensive care unit: progression of disease or errors in emergency department management.
        Pediatr Emerg Care. 2019; 35: 568-574
        • Mangus C.W.
        • Mahajan P.
        Common medical errors in pediatric emergency medicine.
        Clin Pediatr Emerg Med. 2019; 20100714
        • Dewa C.S.
        • Loong D.
        • Bonato S.
        • et al.
        How does burnout affect physician productivity? A systematic literature review.
        BMC Health Serv Res. 2014; 14: 325
        • Hayashino Y.
        • Utsugi-Ozaki M.
        • Feldman M.D.
        • et al.
        Hope modified the association between distress and incidence of self-perceived medical errors among practicing physicians: prospective cohort study.
        PLoS One. 2012; 7e35585
        • Tawfik D.S.
        • Profit J.
        • Morgenthaler T.I.
        • et al.
        Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors.
        Mayo Clin Proc. 2018; 93: 1571-1580
        • Stehman C.R.
        • Testo Z.
        • Gershaw R.S.
        • Kellogg A.R.
        Burnout, drop out, suicide: physician loss in emergency medicine, part I [published correction appears in.
        West J Emerg Med. 2019; 20 (West J Emerg Med. 2019;20(3):485-494. DOI: 10.5811/westjem.2019.4.40970): 840-841
        • Hall L.H.
        • Johnson J.
        • Watt I.
        • et al.
        Healthcare staff wellbeing, burnout, and patient safety: a systematic review.
        PLoS One. 2016; 11e0159015
        • Wisetborisut A.
        • Angkurawaranon C.
        • Jiraporncharoen W.
        • et al.
        Shift work and burnout among health care workers.
        Occup Med (Lond). 2014; 64: 279-286
        • Øyane N.M.
        • Pallesen S.
        • Moen B.E.
        • Akerstedt T.
        • Bjorvatn B.
        Associations between night work and anxiety, depression, insomnia, sleepiness and fatigue in a sample of Norwegian nurses.
        PLoS One. 2013; 8e70228
        • Johnson A.L.
        • et al.
        Sleep deprivation and error in nurses who work the night shift.
        J Nurs Adm. 2014; 44: 17-22
        • Kuhn G.
        Circadian rhythm, shift work, and emergency medicine.
        Ann Emerg Med. 2001; 37: 88-98
        • Turale S.
        • Nantsupawat A.
        Clinician mental health, nursing shortages and the COVID-19 pandemic: crises within crises.
        Int Nurs Rev. 2021; 68: 12-14https://doi.org/10.1111/inr.12674
        • Ruddy R.M.
        • Chamberlain J.M.
        • Mahajan P.V.
        • et al.
        Near misses and unsafe conditions reported in a pediatric emergency research network.
        BMJ Open. 2015; 5e007541
        • Paradiso L.
        • Sweeney N.
        Just culture: it’s more than policy.
        Nurs Manage. 2019; 50: 38-45
        • Khan A.
        • Furtak S.L.
        • Melvin P.
        • et al.
        Parent-reported errors and adverse events in hospitalized children.
        JAMA Pediatr. 2016; 170e154608
        • Sills M.R.
        • Fairclough D.
        • Ranade D.
        • et al.
        Emergency department crowding is associated with decreased quality of care for children.
        Pediatr Emerg Care. 2011; 27: 837-845
        • Kennebeck S.S.
        • Timm N.L.
        • Kurowski E.M.
        • Byczkowski T.L.
        • Reeves S.D.
        The association of emergency department crowding and time to antibiotics in febrile neonates.
        Acad Emerg Med. 2011; 18: 1380-1385
        • Shenoi R.
        • Ma L.
        • Syblik D.
        • Yusuf S.
        Emergency department crowding and analgesic delay in pediatric sickle cell pain crises.
        Pediatr Emerg Care. 2011; 27: 911-917
        • Bekmezian A.
        • Fee C.
        • Bekmezian S.
        • Maselli J.H.
        • Weber E.
        Emergency department crowding and younger age are associated with delayed corticosteroid administration to children with acute asthma.
        Pediatr Emerg Care. 2013; 29: 1075-1081
        • Sagaidak S.
        • Rowe B.H.
        • Ospina M.B.
        • Rosychuk R.J.
        Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study.
        Pediatr Res. 2021; 89: 679-685
        • Sills M.R.
        • Fairclough D.L.
        • Ranade D.
        • Mitchell M.S.
        • Kahn M.G.
        Emergency department crowding is associated with decreased quality of analgesia delivery for children with pain related to acute, isolated, long-bone fractures.
        Acad Emerg Med. 2011; 18: 1330-1338
        • Tekwani K.L.
        • Kerem Y.
        • Mistry C.D.
        • Sayger B.M.
        • Kulstad E.B.
        Emergency department crowding is associated with reduced satisfaction scores in patients discharged from the emergency department.
        West J Emerg Med. 2013; 14: 11
        • Morley C.
        • Unwin M.
        • Peterson G.M.
        • Stankovich J.
        • Kinsman L.
        Emergency department crowding: A systematic review of causes, consequences and solutions.
        PLoS One. 2018; 13e0203316
        • O’Malley A.S.
        After-hours access to primary care practices linked with lower emergency department use and less unmet medical needs.
        Health Aff (Millwood). 2013; 32: 1-9
        • American Academy of Pediatrics, Committee on Pediatric Emergency Medicine
        Policy statement: Overcrowding crisis in our nation’s emergency departments: is our safety net unraveling?.
        Pediatrics. 2004; 114 (Reaffirmed July 2016): 878-888
        • American College of Emergency Physicians, Emergency Practice Committee
        Emergency Department Crowding: High Impact Solutions. Irving, TX: American College of Emergency Physicians.
        Date: 2016
        Date accessed: June 2, 2020
        (2016. Accessed June 2, 2020. Available at: https://www.acep.org/globalassets/sites/acep/media/crowding/empc_crowding-ip_092016.pdf)
        • Barata I.
        • Brown K.M.
        • Fitzmaurice L.
        • Griffin E.S.
        • Snow S.K.
        American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Emergency Medicine Committee; Emergency Nurses Association, Pediatric Committee. Best practices for improving flow and care of pediatric patients in the emergency department.
        Pediatrics. 2015; 135: e273-e283
      3. American College of Emergency Physician Policy on Standardized Protocols for Optimizing Emergency Department Care.
        (Available at:) (Accessed September 20, 2021)
      4. American College of Emergency Physicians. Policy Triage Scale Standardization.
        (Available at:) (Accessed January 10, 2022)
        • Lee J.
        • Rodio B.
        • Lavelle J.
        • et al.
        The impact and safety of an updated anaphylaxis clinical pathway in a busy pediatric emergency department.
        J Allergy Clin Immunol. 2017; 139: AB222
        • Iqbal S.F.
        • Brown K.M.
        Improving timeliness and reducing variability in asthma care through the use of clinical pathways.
        Clin Pediatr Emerg Med. 2018; 19: 52-54
        • Arya R.
        • Wei G.
        • McCoy J.V.
        • Crane J.
        • Ohman-Strickland P.
        • Eisenstein R.M.
        Decreasing length of stay in the emergency department with a split emergency severity index 3 patient flow model.
        Acad Emerg Med. 2013; 20: 1171-1179
        • Copeland J.
        • Gray A.
        A daytime fast track improves throughput in a single physician coverage emergency department.
        Can J Emerg Med. 2015; 17: 648-655
        • Hung G.R.
        • Whitehouse S.R.
        • O’Neill C.
        • Gray A.P.
        • Kissoon N.
        Computer modeling of patient flow in a pediatric emergency department using discrete event simulation.
        Pediatr Emerg Care. 2007; 23: 5-10
        • Howell E.
        • Bessman E.
        • Kravet S.
        • et al.
        Active bed management by hospitalists and emergency department throughput.
        Ann Intern Med. 2008; 149: 804-810
        • Barrett L.
        • Ford S.
        • Ward-Smith P.
        • et al.
        A bed management strategy for overcrowding in the emergency department.
        Nurs Econ. 2012; 30: 82-85
        • Ramsey Z.
        • Palter J.S.
        • Hardwick J.
        • Moskoff J.
        • Christian E.L.
        • Bailitz J.
        Decreased nursing staffing adversely affects emergency department throughput metrics.
        West J Emerg Med. 2018; 19: 496-500https://doi.org/10.5811/westjem.2018.1.36327
        • Guessoum S.B.
        • Lachal J.
        • Radjack R.
        • et al.
        Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown.
        Psychiatry Res. 2020; 291113264
        • Purtle J.
        COVID-19 and mental health equity in the United States.
        Soc Psychiatry Psychiatr Epidemiol. 2020; 55: 969-971
        • Krass P.
        • Doupnik S.K.
        Equity in emergency mental health care.
        Pediatrics. 2021; 147e2020049843
        • Baker D.
        • Battles J.
        • King H.
        New insights about team training from a decade of TeamSTEPPS. Rockville, MD: Agency for Healthcare Research and Quality, Patient Safety Network.
        (; February 2017)
        Date: 2017
        Date accessed: January 13, 2022
        (Accessed January 13, 2022. Available at: https://psnet.ahrq.gov/perspective/new-insights-about-team-training-decade-teamstepps)
        • Brown L.
        • Overly F.
        Simulation-based interprofessional team training.
        Clin Pediatr Emerg Med. 2016; 17: 179-184
        • Lyren A.
        • Brilli R.J.
        • Zieket K.
        • et al.
        Children’s hospitals’ solutions for patient safety collaborative impact on hospital-acquired harm.
        Pediatrics. 2017; 140e20163494
        • Patterson M.D.
        • Geis G.L.
        • LeMaster T.
        • et al.
        Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department.
        BMJ Qual Saf. 2013; 22: 383-393
      5. Agency for Healthcare Research and Quality, Patient Safety Network. Teamwork Training.
        Date: September 2019
        Date accessed: October 10, 2020
        (Available at: https://psnet.ahrq.gov/primers/primer/8)
        • Goode T.
        • Sockalingam S.
        • Snyder L.L.
        • et al.
        Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs. National Center for Cultural Competence, Georgetown University Center for Child and Human Development.
        Date: 2004
        (Accessed September 6, 2020. Available at: http://nccc.georgetown.edu/documents/Cultural_Broker_Guide_English.pdf)
        • Provost S.M.
        • Lanham H.J.
        • Leykum L.K.
        • et al.
        Health care huddles: managing complexity to achieve high reliability.
        Health Care Manage Rev. 2015; 40 (Available at: https://psnet.ahrq.gov/issue/health-care-huddles-managing-complexity-achieve-high-reliability): 2-12
        Date accessed: January 13, 2022
        • Brady P.W.
        • Muething S.
        • Kotagal U.
        • et al.
        Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events.
        Pediatrics. 2013; 131: e298-e308
        • Agency for Healthcare Research and Quality
        Daily Huddles. Rockville, MD: Agency for Healthcare Research and Quality, Patient Safety Network.
        Date: 2017
        (Accessed January 13, 2022. Available at: https://psnet.ahrq.gov/primer/improving-patient-safety-and-team-communication-through-daily-huddles)
        • McBeth C.L.
        • Durbin-Johnson B.
        • Siegel E.O.
        Interprofessional huddle: one children’s hospital’s approach to improving patient flow.
        Pediatr Nurs. 2017; 43: 71-76
        • The Joint Commission
        Sentinel event statistics data: root causes by event type.
        Date accessed: January 20, 2022
        (Available at: https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-event-data-summary/)
        • The Joint Commission
        Improving hand-off communications: meeting national patient safety goal 2E.
        Jt Comm Perspect Patient Saf. 2006; 6: 9-15
        • Venkatesh A.K.
        • Curley D.
        • Chang Y.
        • et al.
        Communication of vital signs at emergency department handoff: opportunities for improvement.
        Ann Emerg Med. 2015; 66: 125-130
        • Maughan B.C.
        • Lei L.
        • Cydulka R.K.
        ED handoffs: observed practices and communication errors.
        Am J Emerg Med. 2011; 29: 502-511
        • Horwitz L.I.
        • Meredith T.
        • Schuur J.D.
        • et al.
        Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care.
        Ann Emerg Med. 2009; 53: 701-710
        • Croskerry P.
        From mindless to mindful practice--cognitive bias and clinical decision making.
        N Engl J Med. 2013; 368: 2445-2448
        • Kessler C.
        • Scott N.L.
        • Siedsma M.
        • Jordan J.
        • Beach C.
        • Coletti C.M.
        Inter-unit handoffs of patients and transfers of information: a survey of current practices.
        Ann Emerg Med. 2014; 64 (343.e5–349)
        • Gopwani P.R.
        • Brown K.M.
        • Quinn M.J.
        • Dorosz E.J.
        • Chamberlain J.M.
        SOUND: a structured handoff tool improves patient handoffs in a pediatric emergency department.
        Pediatr Emerg Care. 2015; 31: 83-87
        • Mullan P.C.
        • Macias C.G.
        • Hsu D.
        • Alam S.
        • Patel B.
        A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification.
        Pediatr Emerg Care. 2015; 31: 231-238
        • Starmer A.J.
        • Spector N.D.
        • Srivastava R.
        • et al.
        • I-PASS Study Group
        I-PASS, a mnemonic to standardize verbal handoffs.
        Pediatrics. 2012; 129: 201-204
        • McCrory M.C.
        • Aboumatar H.
        • Custer J.W.
        • et al.
        “ABC-SBAR” training improves simulated critical patient hand-off by pediatric interns.
        Pediatr Emerg Care. 2012; 28: 538-543
        • Bigham M.T.
        • Logsdon T.R.
        • Manicone P.E.
        • et al.
        Decreasing handoff-related care failures in children’s hospitals.
        Pediatrics. 2014; 134: e572-e579
        • Starmer A.J.
        • Spector N.D.
        • Srivastava R.
        • et al.
        Changes in medical errors after implementation of a handoff program.
        N Engl J Med. 2014; 371: 1803-1812
        • Denham C.R.
        SBAR for patients.
        J Patient Saf. 2008; 4: 38-48
        • Yoshida H.
        • Rutman L.E.
        • Chen J.
        • et al.
        Waterfalls and handoffs: a novel physician staffing model to decrease handoffs in a pediatric emergency department.
        Ann Emerg Med. 2019; 73: 248-254
      6. American College of Emergency Physicians. ACEP policy on Staffing Models and the Role of the Emergency Department Medical Director.
        (Available at:) (Accessed September 20, 2021)
        • Cheung D.S.
        • Kelly J.J.
        • Beach C.
        • et al.
        Improving handoffs in the emergency department.
        Ann Emerg Med. 2010; 55: 171-180
        • Zorc J.J.
        • Hoffman J.M.
        • Harper M.B.
        IT in the ED: a new section of pediatric emergency care.
        Pediatr Emerg Care. 2012; 28: 1399-1401
        • Sethuraman U.
        • Kannikeswaran N.
        • Murray K.P.
        • et al.
        Prescription errors before and after introduction of electronic medication alert system in a pediatric emergency department.
        Acad Emerg Med. 2015; 22: 714-719
        • Atabaki S.M.
        • Jacobs B.R.
        • Brown K.M.
        • et al.
        Quality improvement in pediatric head trauma with PECARN rules implementation as computerized decision support.
        Pediatr Qual Saf. 2017; 2: e019
        • Melton K.R.
        • Timmons K.
        • Walsh K.E.
        • Meinzen-Derr J.K.
        • Kirkendall E.
        Smart pumps improve medication safety but increase alert burden in neonatal care.
        BMC Med Inform Decis Mak. 2019; 19: 213
        • Damhoff H.N.
        • Kuhn R.J.
        • Baker-Justice S.N.
        Medication preparation in pediatric emergencies: comparison of a web-based, standard-dose, bar code-enabled system and a traditional approach.
        J Pediatr Pharmacol Ther. 2014; 19: 174-181
        • Schinasi D.A.
        • Atabaki S.M.
        • Lo M.D.
        • et al.
        Telehealth in pediatric emergency medicine.
        Curr Probl Pediatr Adolesc Health Care. 2021; 51100953
        • Varma S.
        • Schinasi D.A.
        • Ponczek J.
        • et al.
        A retrospective study of children transferred from general emergency departments to a pediatric emergency department: which transfers are potentially amenable to telemedicine?.
        J Pediatr. 2021; 230: 126-132.e1
        • Dharmar M.
        • Romano P.S.
        • Kuppermann N.
        • et al.
        Impact of critical care telemedicine consultations on children in rural emergency departments.
        Crit Care Med. 2013; 41: 2388-2395
        • Ray K.N.
        • Demirci J.R.
        • Bogen D.L.
        • Mehrotra A.
        • Miller E.
        Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians.
        Telemed J E Health. 2015; 21: 622-629
        • Shafaf N.
        • Malek H.
        Applications of machine learning approaches in emergency medicine; a review article.
        Arch Acad Emerg Med. 2019; 7: e34
      7. John Hopkins Medicine (n.d.). Center for Data Science in Emergency Medicine. Accessed online 03082021.
        • Gausche-Hill M.
        • Ely M.
        • Schmuhl P.
        • et al.
        A national assessment of pediatric readiness of emergency departments.
        JAMA Pediatr. 2015; 169: 527-534
        • Doherty C.
        • Mc Donnell C.
        Tenfold medication errors: 5 years’ experience at a university-affiliated pediatric hospital.
        Pediatrics. 2012; 129: 916-924
        • American College of Emergency Physicians
        Clinical Pharmacist Services in the Emergency Department. Irving, TX: American College of Emergency Physicians 2021.
        Date accessed: November 16, 2020
        (Available at: https://www.acep.org/patient-care/policy-statements/clinical-pharmacist-services-in-the-emergency-department/)
        • American Society of Health-System Pharmacists
        ASHP guidelines on emergency medicine pharmacist services.
        Date accessed: November 16, 2019
        (Available at: https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/emergency-medicine-pharmacist-services.ashx)
        • Patanwala A.E.
        • Sanders A.B.
        • Thomas M.C.
        • et al.
        A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department.
        Ann Emerg Med. 2012; 59: 369-373
        • Subramanyam R.
        • Mahmoud M.
        • Buck D.
        • et al.
        Infusion medication error reduction by two-person verification: a quality improvement initiative.
        Pediatrics. 2016; 138e20154413
        • Institute for Safe Medication Practices (ISMP)
        ISMP Targeted Medication Safety Best Practices for Hospitals.
        Date: 2020
        Date accessed: January 28, 2022
        (Available at: https://www.ismp.org/guidelines/best-practices-hospitals)
        • The Joint Commission
        National Patient Safety Goals Effective January 2022 for the Critical Access Hospital Program.
        Date accessed: January 28, 2022
        (Available at: https://www.jointcommission.org//media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_hap_jan2022.pdf)
        • Coté C.J.
        • Wilson S.
        • American Academy of Pediatrics; American Academy of Pediatric Dentistry
        Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures.
        Pediatrics. 2019; 143e20191000
        • Koller D.
        • Rummens A.
        • Le Pouesard M.
        • et al.
        Patient disclosure of medical errors in paediatrics: a systematic literature review.
        Paediatr Child Health. 2016; 21: e32-e38
        • American Academy of Pediatrics
        Committee on Medical Liability and Risk Management, Council on Quality Improvement and Patient Safety. Disclosure of adverse events in pediatrics.
        Pediatrics. 2016; 138e20163215
        • Needle S.
        • Wright J.
        American Academy of Pediatrics, Disaster Preparedness Advisory Council, Committee on Pediatric Emergency Medicine. Ensuring the health of children in disasters.
        Pediatrics. 2015; 136: e1407-e1417
        • American Academy of Pediatrics
        Disaster Preparedness Advisory Council; Massachusetts General Hospital Center for Disaster Medicine. Family Reunification Following Disasters: A Planning Tool for Health Care Facilities [Toolkit].
        Date: July 2018
        Date accessed: January 13, 2022
        (Available at: https://www.aap.org/en-us/Documents/AAP-Reunification-Toolkit.pdf)
        • Chung S.
        • Baum C.R.
        • Nyquist A.C.
        American Academy of Pediatrics, Disaster Preparedness Advisory Council, Council on Environmental Health, Committee on Infectious Diseases. Policy statement: Chemical-biological terrorism and its impact on children.
        Pediatrics. 2020; 145e20193749
        • Schonfeld D.J.
        • Melzer-Lange M.
        • Hashikawa A.N.
        • et al.
        American Academy of Pediatrics, Council on Children and Disasters, Council on Injury, Violence, and Poison Prevention, Council on School Health. Policy statement: Participation of children and adolescents in live crisis drills and exercises.
        Pediatrics. 2020; 146e2020015503
        • Hewett E.K.
        • Nagler J.
        • Monuteaux M.C.
        • et al.
        A hazardous materials educational curriculum improves pediatric emergency department staff skills.
        AEM Educ Train. 2017; 2: 40-47
        • Bank I.
        • Khalil E.
        Are pediatric emergency physicians more knowledgeable and confident to respond to a pediatric disaster after an experiential learning experience?.
        Prehosp Disaster Med. 2016; 31: 551-556
        • Amsel L.
        • Cheslak-Postava K.
        • Musa G.
        • et al.
        The broad impact of childhood trauma: physical-psychiatric comorbidity in a cohort of individuals exposed to 9/11 in childhood.
        Presented at: 175th Annual Meeting of the American Psychiatric Association, San Francisco, California. 2019; (May 18-22, 2019; p 8-124): 18-22
      8. Emergency Medical Services for Children Improvement and Innovation Center. Pediatric Disaster Preparedness Toolkit.
        Date accessed: January 28, 2022
        (Available at: https://emscimprovement.center/education-and-resources/toolkits/pediatric-disaster-preparedness-toolbox/)
      9. American Academy of Pediatrics. Pediatric Tabletop Exercise Resource Kit and Other Key Resources for Disaster Preparedness.
        Date accessed: January 13, 2022
        (Available at: https://collaborate.aap.org/tabletopexercises/Pages/default.aspx)
      10. American Academy of Pediatrics. Pediatric Disaster Preparedness And Response Topical Collection Chapter 6: Pediatric Preparedness Exercises.
        Date accessed: January 13, 2022
        (Available at: https://downloads.aap.org/DOCHW/Topical-Collection-Chapter-6.pdf)
        • So M.
        • Dziuban E.J.
        • Franks J.L.
        • et al.
        Extending the reach of pediatric emergency preparedness: a virtual tabletop exercise targeting children’s needs.
        Public Health Rep. 2019; 134: 344-353

      Biography

      Madeline M. Joseph, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine—Jacksonville, Jacksonville, Florida; University of Florida Health Sciences Center—Jacksonville, Jacksonville, Florida.

      Biography

      Prashant Mahajan, Departments of Pediatrics and Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

      Biography

      Sally K. Snow, Independent Consultant in Pediatric Emergency and Trauma Nursing.

      Biography

      Brandon C. Ku, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

      Biography

      Mohsen Saidinejad, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California.