a)
Professional Staff: Physicians
1)
Qualifications
A) All physicians shall have
training in the care of pediatric patients through residency training, clinical
training, or practice.
B) All
physicians shall successfully complete and maintain current recognition in the
AHA-AAP or American Red Cross PALS or the ACEP-AAP APLS. Physicians who are
board certified or eligible in emergency medicine (ABEM or AOBEM) or in
pediatric emergency medicine (ABP/ABEM) are excluded from this requirement.
PALS and APLS shall include both cognitive and practical skills
evaluation.
2)
Continuing Medical Education
All full and part-time emergency physicians caring for
children in the emergency department or fast track/urgent care area shall have
documentation of a minimum of 16 hours of continuing medical education (AMA
Category I or II) in pediatric emergency topics every two years. CME hours
shall be earned by, but not limited to, verified attendance at or participation
in formal CME programs (i.e., Category I) or informal CME programs (i.e.,
Category II), all of which shall have pediatrics as the majority of their
content. The CME may be obtained from a pediatric specific program/course or
may be a pediatric lecture/presentation from a workshop/conference. To meet
Category II, teaching time needs to have undergone review and received approval
by a university/hospital as Category II CME. The Illinois Department of
Financial and Professional Regulation can provide guidance related to criteria
for acceptable Category I or II credit.
3) Coverage
At least one physician meeting the requirements of subsection
(a)(1), or a nurse practitioner, clinical nurse specialist, or PA meeting the
requirements of subsection (b)(1), shall be on duty in the emergency department
24 hours a day or immediately available in person. A policy shall define when a
physician is to be consulted or called in at times when the emergency
department is covered by one of these clinicians.
4) Consultation
Telephone consultation with a physician who is board
certified or eligible in pediatrics or pediatric emergency medicine shall be
available 24 hours a day. Consultation may be with an on-call physician or in
accordance with Appendix M.
5) Physician, Nurse Practitioner, Clinical
Nurse Specialist, Physician Assistant Backup
A backup physician, nurse practitioner, clinical nurse
specialist, or PA whose qualifications and training are equivalent to that
required by subsections (a) and (b) shall be available in person to the SEDP,
within one hour after notification, to assist with critical situations,
increased surge capacity or disasters.
6) On-Call Physicians
Guidelines shall address response time for on-call
physicians.
b)
Professional Staff: Nurse Practitioner, Clinical Nurse Specialist and Physician
Assistant
This subsection (b) pertains to nurse practitioners, clinical
nurse specialists, and PAs working within their scope of practice, and
credentialed as defined by the hospital.
1) Qualifications
A) Nurse practitioners shall:
i) Successfully Complete a Nurse Practitioner
Program with a Focus on the Pediatric Patient. The following are programs that
qualify as focused on pediatric patients: acute care pediatric nurse
practitioner program, primary care pediatric nurse practitioner program,
pediatric critical care nurse practitioner program, emergency nurse
practitioner program, or family practice nurse practitioner program;
or
ii) Alternate Criteria: The
nurse practitioner worked in the emergency department prior to January 1, 2018
and has completed at least 2000 hours of hospital-based emergency department
experience or acute care experience as a nurse practitioner over the last
24-month period that includes the care of pediatric patients. This must be
certified in writing by the hospitals at which the hours were
completed.
iii) Current Illinois
APRN license. For out-of-state facilities with Illinois recognition under the
EMS, trauma, or pediatric program, the nurse practitioner shall have an
unencumbered license in the state in which he or she practices.
iv) Credentialing that reflects orientation,
ongoing training and specific competencies in the care of the pediatric
emergency patient, as defined by the hospital credentialing process.
B) Clinical nurse specialists
shall:
i) Complete a clinical nurse specialist
program that includes pediatrics;
ii) Maintain pediatric clinical nurse
specialist certification through a nationally recognized organization (American
Association of Critical Care Nurses (AACN), American Nurses Credentialing
Center (ANCC), or an equivalent national organization);
iii) Hold a current Illinois APRN license.
For out-of-state facilities with Illinois recognition under the EMS, trauma, or
pediatric program, the clinical nurse specialist shall have an unencumbered
license in the state in which he or she practices; and
iv) Provide credentialing that reflects
orientation, ongoing training, and specific competencies in the care of the
pediatric emergency patient, as defined by the hospital credentialing
process.
C) Physician
Assistants shall:
i) Hold a current Illinois
Physician Assistant License. For out-of-state facilities with Illinois
recognition under the EMS, trauma, or pediatric program, the professional shall
have an unencumbered license in the state in which he or she
practices.
ii) Provide
credentialing that reflects orientation, ongoing training and specific
competencies in the care of the pediatric emergency patient as defined by the
hospital credentialing process.
2) Continuing Education
A) All full- and part-time nurse
practitioners, clinical nurse specialists, and PAs caring for children in the
emergency department shall successfully complete and maintain current
recognition in one of the following courses: the AHA-AAP or American Red Cross
PALS, the ACEP-AAP APLS or the Emergency Nurses Association (ENA) Emergency
Nursing Pediatric Course (ENPC). PALS, APLS and ENPC shall include both
cognitive and practical skills evaluation.
B) All full- and part-time nurse
practitioners, clinical nurse specialists, and PAs caring for children in the
emergency department and fast track/urgent care area shall have documentation
of a minimum of 16 hours of continuing education in pediatric emergency topics
every two years that are approved by an accrediting agency.
c) Professional Staff:
Nursing
1) Qualifications
At least one RN on duty each shift who is responsible for the
direct care of the child in the emergency department shall successfully
complete and maintain current recognition in one of the following courses in
pediatric emergency care:
A) AHA-AAP
or American Red Cross PALS;
B)
ACEP-AAP APLS; or
C) ENA
ENPC.
2) Continuing
Education
A) At least one RN on duty on each
shift who is responsible for the direct care of the child in the emergency
department shall have documentation of a minimum of eight hours of pediatric
emergency or critical care continuing education every two years. Continuing
education may include, but is not limited to, PALS, APLS or ENPC; CEU
offerings; case presentations; competency testing; teaching courses related to
pediatrics; and publications. The continuing education hours may be integrated
with other existing continuing education requirements, provided that the
content is pediatric specific. PALS, APLS and ENPC shall include both cognitive
and practical skills evaluation.
B)
All emergency department nurses (RNs and LPNs) shall complete a yearly
competency review of high-risk, low-frequency procedures based on their
pediatric population.
d) Policies and Procedures
1) Inter-facility Transfer
A) The hospital shall have current written
transfer agreements that cover pediatric patients. The transfer agreements
shall include a provision that addresses communication and quality improvement
measures between the sending and receiving hospitals, as related to patient
stabilization, treatment prior to and subsequent to transfer, and patient
outcome.
B) The hospital shall have
written pediatric inter-facility transfer guidelines, policies, or procedures
concerning transfer of critically ill and injured patients, which include a
defined process for initiation of transfer, including the roles and
responsibilities of the sending hospital and receiving hospital; a process for
selecting the appropriate care facility; a process for selecting the
appropriately staffed transport service to match the patient's acuity level; a
process for patient transfer (including obtaining informed consent); a plan for
transfer of patient medical record information, signed transport consent, and
belongings; and a plan for provision of directions and receiving hospital
information to the family. Incorporating the components of Appendix M into the
emergency department transfer policy/procedure will meet this
requirement.
2)
Suspected Child Abuse and Neglect
The hospital shall have policies/procedures addressing child
abuse and neglect. These policies/procedures shall include, but not be limited
to: the identification (including the screening process and screening questions
within the electronic medical record), evaluation, treatment and referral to
DCFS of victims of suspected child abuse and neglect in accordance with State
law.
3) Emergency
Department Treatment Guidelines
The hospital shall have interprofessional emergency
department pediatric specific treatment guidelines, clinical pathways, or
protocols addressing initial assessment and management, including decision
points, for the care of the high-volume and high-risk pediatric population
(i.e., fever, trauma, respiratory distress, seizures).
4) Latex-Allergy Policy
The hospital shall have a policy addressing the assessment of
latex allergies and the availability of latex-free equipment and
supplies.
5) Disaster
Preparedness
The hospital shall integrate pediatric components into its
Disaster Plan or Emergency Operations Plan, based on the EMSC Hospital
Pediatric Preparedness Checklist.
e) Quality Improvement
1) Interprofessional Quality Activities
Policy
A) Pediatric emergency medical care
shall be included in the SEDP's emergency department or section QI program and
reported to the hospital Quality Committee.
B) Interprofessional quality improvement
processes/ activities shall be established (e.g., committee).
C) Quality monitors shall be documented that
address pediatric care within the emergency department, with identified
clinical indicators, monitor tools, defined outcomes for care, feedback loop
processes and target timeframes for closure of issues. These activities shall
include children from birth up to and including 15 years of age and shall
consist of, but are not limited to, all emergency department:
i) Pediatric deaths;
ii) Pediatric inter-facility
transfers;
iii) Child abuse and
neglect cases;
iv) Critically ill
or injured children in need of stabilization (e.g., respiratory failure,
sepsis, shock, altered level of consciousness, cardio/pulmonary failure;
and
v) Pediatric quality and safety
priorities of the institution.
D) Interprofessional pediatric mock codes and
debriefings shall be conducted and documented including follow-up on identified
opportunities for improvement.
E)
All information contained in or relating to any medical audit/quality
improvement monitor performed of a PCCC's, EDAP's or SEDP's pediatric
services
pursuant to this Section
shall be afforded
the same status as is provided information concerning medical studies in
Article VIII, Part 21 of the Code of Civil Procedure. (Section
3.110(a) of the
Act)
2) Pediatric
Physician Champion
The emergency department medical director shall appoint a
physician to champion pediatric activities (i.e. quality/performance
improvement, clinical pathways, education/training). The pediatric physician
champion shall work with and provide support to the pediatric quality
coordinator.
3) Pediatric
Quality Coordinator
A member of the professional staff who has ongoing
involvement in the care of pediatric patients shall be designated to serve in
the role of the pediatric quality coordinator. The pediatric quality
coordinator shall have a job description that includes the allocation of
appropriate time and resources by the hospital. This individual may be employed
in an area other than the emergency department provided he or she has a minimum
of 3600 hours of pediatric critical care experience or emergency department
experience. Working with the pediatric physician champion, the responsibilities
of the pediatric quality coordinator shall include:
A) Working in conjunction with the ED nurse
manager and ED medical director to ensure compliance with and documentation of
the pediatric continuing education of all emergency department professional
staff in accordance with subsections (a), (b) and (c).
B) Coordinating data collection for
identified clinical indicators and outcomes (see subsection
(e)(1)(C)).
C) Reviewing selected
pediatric cases transported to the hospital by pre-hospital providers and
providing feedback to the EMS Coordinator/System.
D) Participating in regional QI activities,
including preparing a written QI report and attending the Regional Pediatric QI
subcommittee meetings. These activities shall be supported by the hospital. One
representative from the Regional QI subcommittee shall report to the EMS
Regional Advisory Board.
E)
Providing QI information to the Department upon request. (See Section
3.110(a) of the
Act.)
f)
Equipment, Trays, and Supplies
See Section 515.Appendix L.
