Prioritising minimum standards of emergency care for children in resource-limited settings

Abstract

Background: There is global variation in the ability of hospital-based emergency centres to provide paediatric emergency medicine (PEM) services. Although minimum standards have been proposed, they may not be applicable in resource-limited settings.

Objective:The goal was to identify reasonable minimum standards to provide safe and effective care for acutely ill children in resource-limited settings.

Methods: Using previously proposed standards from the International Federation of Emergency Medicine (IFEM), a modified Delphi approach was used to reach agreement regarding minimum standards for PEM in resource-limited settings. Three rounds of surveys were electronically distributed to physicians working in resource-limited settings. Those standards with >67% agreement advanced to the subsequent round.

Results: The categories of the surviving criteria included integrated service design, child and family-friendly care, initial assessment of the ill child, stabilising and treating an ill child, staff training and competence, equipment, supplies and medications, quality and safety, child protection, and advanced training and academic research.

Conclusions: Experts with experience in acute care of children in resource-limited settings have prioritised standards for paediatric emergency care. They identified 26 variables in nine domains from the original IFEM list of standards and two additional free text standards for the care of acutely ill children. This list may serve as a helpful guide for emergency centres to provide medical treatment for acutely ill children in resource-limited settings.

Keywords:

• Paediatric
• Emergency
• Global health
• International
• Standards of care

Acknowledgments

The authors would like to thank the following members of the Expert Panel who contributed to this Delphi-based study: Bobby Kapur, Andrew Kestler, Guillermo Loncorica, Javier Prego, Ffion Davies, Swathi Padankatti, Isaac Kihurani and E. Ulas Saz.