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Children’s emergency departments are struggling to provide a 24/7 service resulting in a real threat that care delivered to children will be compromised, says a leading children’s doctor.

Between 2006-07 and 2015-16, there was a 30% increase in emergency department attendances for under ones and 28% for one to four-year-olds.

The Facing the Future: standards for children in emergency care settings, published today by an expert working group led by the RCPCH, wants to see specialist paediatric expertise underpin all urgent and emergency care services, building capability and confidence among the professionals who assess children such as GPs, health visitors, paramedics and pharmacists. It says an increase in specialist doctors combined with additional child health training across urgent care and community settings will be key to redirect children to more appropriate services, reducing pressure on stretched emergency departments.

“These standards help emergency departments plan and develop the best care possible for children using urgent and emergency services and without investment in the workforce it simply won’t be possible for the standards to be met. It’s purely down to the sheer dedication of doctors and nurses working in these departments that the service is staying afloat.”

Dr John Criddle, Clinical Lead and member of the Royal College of Paediatrics and Child Health (RCPCH)

The standards, which are applicable UK-wide, aim to strengthen the care delivered by children’s emergency services and reduce the burden on them. Standards include:

• staff assessing children in urgent care centres or walk-in clinics must have the appropriate paediatric competence to provide immediate assessment
• all emergency departments which see children must have a consultant in Paediatric Emergency Medicine who leads the service
• all children who are directed away from an emergency care setting must be assessed by a clinician with paediatric competences and experience in paediatric initial assessment within pre-agreed parameters including basic observations
• every emergency department treating children must be staffed with a minimum of two registered children’s nurses
• emergency clinicians with responsibility for the care of children receive training in how to assess risk and immediately manage children’s mental health needs and support their family/carers
• telephone availability of a paediatric mental health practitioner and other specialists 24hours a day, 7 days a week, for advice and able to attend for assessment when appropriate
• the primary care team, including GP and health visitor/school nurse and named social worker, are informed, within an agreed timescale, of each attendance.

Children are frequent users of emergency departments and year-on-year there has been a 5% increase in paediatric urgent and emergency care attendance across the UK for minor ailments. 

Dr Criddle said:

“As a service under pressure, more needs to be done to ensure the sickest children end up in emergency departments, and those with non-urgent health needs, are directed to other more appropriate services. Providing child health training to all healthcare professionals who assess children will support them to be seen by the most appropriate healthcare professional at the right place and at the right time, further reducing pressure on departments by driving traffic to more appropriate services, often much closer to home.

"There are several reasons why children end up in emergency departments – some have complex conditions making diagnosis difficult while others have been seen by healthcare professionals who are not confident diagnosing children due to lack of child health training. And due to a fragmented system, communication between teams is difficult resulting in a lack of continuity of care, increasing urgent and emergency admissions. It’s apparent that the system needs to be simplified, made more accessible and responsive to the needs of local communities. These standards aim to support this.”

Outside the health system, there is a lot of work that’s needed to improve public awareness. Families aren’t always aware that walk-in clinics and pharmacists are on hand.

“Several reports have shown that parents prefer to seek advice from their General Practitioner (GP) and tend to do so an average of six times per year for children under four. Widening access to GPs would have a major impact on relieving pre-hospital urgent care pressures but less than half of GPs have an opportunity to undertake specialist hospital paediatric training. GPs and other community health workers need to be properly supported -additional paediatric training and access to specialist paediatric telephone advice will help this.  Practices whose patients report better access also have 10% fewer visits (2,500 per year) to emergency departments so an investment now will save resources in the long-term.”

The Facing the Future: standards for children in emergency care settings will be audited in 2021 and updated in 2022-23.