1. The Organizational Structure Of The European Paediatric Emergency Department: A Descriptive Pilot Study Mintegi S *, Shavit I **, Benito J * * Cruces Hospital. Bilbao. Basque Country. Spain ** Rambam Medical Center. Haifa. Israel Mintegi S *, Shavit I **, Benito J * * Cruces Hospital. Bilbao. Basque Country. Spain ** Rambam Medical Center. Haifa. Israel

2. Background The paediatric population requires an independent emergency service adapted to the degree of acuity of the illness or injury and to the age of the patient PEDs must have the necessary equipment, staff and policies to provide a high quality of care for children; this is well defined in some countries (US and Canada) No studies in Europe The paediatric population requires an independent emergency service adapted to the degree of acuity of the illness or injury and to the age of the patient PEDs must have the necessary equipment, staff and policies to provide a high quality of care for children; this is well defined in some countries (US and Canada) No studies in Europe

3. Objective To examine the organisational structure of Paediatric Emergency Departments in Europe.

4. Methods 30-point electronic questionnaire –sent to European Paediatric Emergency Department (PED) directors through the REPEM (Research in European Paediatric Emergency Medicine- http://www.pemdatabase.org/REPEM-sites.html) network of EuSEM Three major categories: –description of paediatric in-patient capabilities –description of the scope of services –description of the professional staff structure. 30-point electronic questionnaire –sent to European Paediatric Emergency Department (PED) directors through the REPEM (Research in European Paediatric Emergency Medicine- http://www.pemdatabase.org/REPEM-sites.html) network of EuSEM Three major categories: –description of paediatric in-patient capabilities –description of the scope of services –description of the professional staff structure.

5. Results Belgium3 France8 Germany3 Hungary1 Israel2 Italy4 Norway1 Portugal1 Saudi Arabia2 Spain8 Sweden1 Switzerland2 Turkey12 United Kingdom5 65 questionnaires 53 tertiary medical centres 14 countries 65 questionnaires 53 tertiary medical centres 14 countries

6. Results 1.748.313 episodes in 2006 Age of admission to the PED: 13-18 years –Most of the tertiary PEDs admit patients over 14 years (40, 75.5%). 1.748.313 episodes in 2006 Age of admission to the PED: 13-18 years –Most of the tertiary PEDs admit patients over 14 years (40, 75.5%).

7. Results – Pediatric in-patient capabilities Paediatric Emergency Department86.8% Triage room69.8% Computerized patient tracking systems58.5% Waiting room96.2% Procedures room96.2% Resuscitation room96.2% Observation room84.9% Affiliation to a University84.9%

8. Results – Pediatric in-patient capabilities In-patient Paediatric Department96.2% Paediatric Intensive Care Unit90.6% Paediatric trauma service71.7%

9. Results – Scope of services n% Presence of triage guidelines4788.7 Presence of child abuse policies4890.6 Availability of social services No such service By follow-up consultation By consultation with social worker 9 15 29 17.0 28.3 54.7 Procedural sedationNo such practice Provided by the hospital sedation team Provided by the Adult ED staff Provided by the PED staff 4 7 1 41 7.5 13.2 1.9 77.4 Level of sedation provided Mild sedation only Mild/moderate sedation Mild/moderate/deep sedation 8 20 25 15.1 37.7 47.2

10. Results – Professional staff structure n% Medical director specialty Paediatrician5196.2 Medical director’s training in PEM No training Non formal training PEM fellowship (US, Canada, AUS, UK) 5 35 13 9.4 66.0 24.5 Medical director qualification in Paediatric resuscitation Does not hold an APLS course Provider of an APLS course Instructor/director of an APLS course 6 15 32 11.3 28.3 60.4 ED staffing structurePEM fellowship trained physicians, Paediatricians,residents Paediatricians, residents Residents only 20 31 2 37.7 58.5 3.8 24 hours a day - 7 days a week coverage by Paediatricians or PEM fellowship trained physicians 4483.0

11. Limitations Sample relatively small Selection bias: –only countries affiliated to EuSEM were included –some countries do not belong to the European Union Only three determinants of quality of care: –Triage –Availability of social services –Procedural sedation No data of the nursing staff No data on research activity Sample relatively small Selection bias: –only countries affiliated to EuSEM were included –some countries do not belong to the European Union Only three determinants of quality of care: –Triage –Availability of social services –Procedural sedation No data of the nursing staff No data on research activity

12. Conclusions The findings of this pilot study indicate that the organisational structure of some European Paediatric Emergency Departments may not be adequate to achieve an optimal patient outcome.

13. Conclusions Establishing training programmes in paediatric emergency medicine could contribute to better paediatric emergency care.