Facility Categorization Toolbox

Hospitals and/or emergency departments are not all alike. Differences are typically a reflection of specialized services available within each facility. Hospital categorization and/or delineation of specific services are not new processes: trauma centers, burn centers, perinatal centers, and stroke centers have existed for years or even decades.

The 2006 Institute of Medicine (IOM) report, Emergency Care for Children, Growing Pains, supports the categorization of emergency care for children. Experts agree that a categorization system for hospitals capable of providing essential resources for children should have the following in place:

• Pediatric-specific equipment;
• Caregivers (i.e. nurses and physicians) trained in pediatric emergency/resuscitation care;
• Pediatric-specific policies and protocols;
• A system for monitoring the care rendered to children and pediatric performance improvement;
• Organized transfer processes, agreements, and guidelines to move children to more resources when needed; and
• Processes to assure the integration of families.

HEALTHCARE PROVIDER RESOURCES

Emergency Medical Services for Children (EMSC) National Resource Center (NRC)

• Making Trauma Systems Work for Injured Children – EMSC Performance Measures Can Make a Difference, an Internet Archive Webcast. This Internet presentation covers such topics as:
  • Pediatric field triage and transfer of the injured child to appropriate resources
  • System processes that assure appropriate resources for critically ill and injured children; and
  • Critical components of pediatric trauma care that contribute to improved outcomes. (Accessed November 2008)

• EMSC State Partnership Performance Measures. Federal grantees are required to report on specific performance measures related to their grant-funded activities. The measures are part of the Government Performance Results Act (GPRA). Measures address operational capacity to provide pediatric emergency care, including the existence of a standardized statewide, territorial, or regional system that recognizes hospitals capable of stabilizing and /or managing pediatric medical emergencies and trauma. An archived webcast. regarding the performance measures also is available. (Accessed November 2008)

American Academy of Pediatrics

• Access to Pediatric Emergency Medical Care. This policy statement encourages emergency departments to establish transfer agreements with facilities with higher levels of pediatric care to ensure timely access to pediatric emergency medical care for critically ill and injured children. (2000)

• Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital. This clinical report provides guidance to community hospitals on essential equipment and needed policies/procedures, referral networks, and transfer of pediatric patients. (2003)

American College of Emergency Physicians

• Care of Children in the Emergency Department: Guidelines for Preparedness. Developed by the American College of Emergency Physicians and approved by 17 national organizations, these guidelines are intended for all hospital emergency departments providing emergency care 24 hours a day, 7 days a week, and continuously staffed by a physician. (2000)

Centers for Disease Control and Prevention

• Access to Trauma Centers in the United States fact sheet and companion interactive mapping tool. This new mapping tool, created in partnership with the American Trauma Society and the University of Pennsylvania, shows the location of all hospitals and trauma centers (Levels I-IV) throughout the country. Individuals can click on the map and find the distance to and locations of trauma centers and hospitals closest to them. (2009)

• Availability of Pediatric Services and Equipment in Emergency Departments: United States, 2002-03.This report presents estimates on the availability of pediatric services, expertise, and supplies for treating pediatric emergencies in U.S. hospitals. Categorization of emergency departments will assure the availability of pediatric services, expertise, and supplies needed in managing pediatric emergencies. (2006)

Health Resources and Services Administration, U.S. Department of Health and Human Services

• Model Trauma System Planning and Evaluation. This living document is a guide to modern statewide trauma system development. It serves as an update to the Health Resources and Services Administration’s 1992 Model Trauma Care System Plan. The document is designed to provide trauma care professionals, public health officials, and health care policy experts needed direction for implementing the public health approach, a scientifically-proven method, when developing and evaluating trauma systems. Defining the essential criteria for hospitals providing emergency trauma care for children is part of planning and monitoring progress of state trauma systems. (Accessed November 2008)

Institute of Medicine

• Emergency Care for Children: Growing Pains. The Institute of Medicine’s (IOM) Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S. and to create a vision for the future of emergency care. In 2006, the committee released “Growing Pains,” an analysis of: the role of pediatric emergency services as an integrated component of the overall health system; system-wide pediatric emergency care planning, preparedness, coordination, and funding; pediatric training in professional education; and research in pediatric emergency care. The document has numerous references to the need for pediatric emergency categorization. (2006)

• The Future of Emergency Care: Key Findings and Recommendations. Drawn from the 2006 Future of Emergency Care report series, this fact sheet summarizes the critical findings of the IOM committees. Most cogent is that “EMS and EDs are not well equipped to handle pediatric care.” Categorization of emergency departments for children should aid in preparedness for the provision of pediatric emergency care. (2006)

Society of Critical Care Medicine

• Consensus Report for Regionalization of Services for Critically Ill or Injured Children. This document establishes recommendations for developing regionalized integration of the care of these children into the emergency medical services system. Pediatricians developed these recommendations with expertise in pediatric critical care, transport, and emergency medicine from the Pediatric Section of the Society of Critical Care Medicine Task Force on Regionalization of Pediatric Critical Care and the Committee on Pediatric Emergency Medicine from the American Academy of Pediatrics. (2000)

• Guidelines and Levels of Care for Pediatric Intensive Care Units. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education. (2004)

EXAMPLE PRACTICES

Illinois EMSC Facility Recognition Program. In 1995, Illinois embarked on a voluntary process to identify the readiness and capabilities of hospitals and their staffs to provide optimal pediatric emergency and critical care. A multidisciplinary subcommittee of their EMSC advisory committee defined criteria for three levels of pediatric emergency care:

• Standby emergency department for pediatrics (SEDP);
• Emergency department approved for pediatrics (EDAP); and
• Pediatric critical care center (PCC).

Illinois has successfully designated more than 200 hospitals at one of the three levels. A detailed history about the program; information on designation criteria and the implementation process, including their hospital application kits; and a listing of Illinois EDAP facilities can be found on this site. (Accessed November 2008)

Oklahoma’s Medical Facilities Division. Oklahoma has had a mandatory hospital categorization process in place since 1998. Rules and regulations exist which define both service categorization and resource availability level. This process is monitored by the Division of Hospital Licensure. Hospitals may be classified as cardiac, pediatric, neurological, etc. Within each specialty classification, there can be Levels 1 to 4 with Level I having the most resources available for the critically ill and or injured. 

Presently, the state of Oklahoma has 138 hospitals classified as pediatric at the various levels of categorization. More information regarding Oklahoma’s rules and regulations can be found by clicking on the above hyperlink. Once here, click on "Chapter 667" within the first bullet. (Accessed November 2008)

Tennessee Board for Licensing Health Care Facilities. Tennessee has a mandatory categorization process in place for hospitals providing care to children. EMSC legislation was passed in 1998 with rules and regulations promulgated to ensure compliance. The rules have recently been strengthened and opened for public comment. Rules define the education of pediatric care providers, essential equipment, care protocols, and care monitoring requirements.

Tennessee has outlined criteria for four levels of pediatric care categorization: comprehensive regional pediatric care facility; general pediatric care facility; primary pediatric care facility, and basic pediatric care facility. A copy of their new rules is available for viewing by clicking on the above hyperlink. (Accessed November 2008)

FAMILY AND CAREGIVER RESOURCES

American College of Emergency Physicians

• Emergency Care of Children. This fact sheet answers questions that parents may have about emergency care for children, such as:

  • Which local emergency department is best for your child?
  • What role do pediatric emergency specialists play in the care of your child?
  • What emergency physicians are doing to improve the care of children?
  • How to make sure your child gets appropriate treatment in an emergency? (Accessed November 2008)

American College of Emergency Physicians

• Family Member Presence in the Emergency Room. This fact sheet, designed in a question-and-answer format, addresses key issues in having family members present in the emergency department and their interactions with the physician. (Accessed November 2008)

• When Your Child Has an Emergency. This fact sheet provides information on how to recognize and respond to an emergency involving a child. It also includes a section on what to bring to the emergency department to help the physician provide better care to the child. (2002)

• What Was Your Experience in the Emergency Room? The American College of Emergency Physicians provides a mechanism to report both good and bad experiences in an emergency room. Information collected is used to help improve patient care at the national level through policy development and training. (Accessed November 2008)