PEDIATRICS Vol. 103 No. 5 May 1999, pp. 1048-1049

AMERICAN ACADEMY OF PEDIATRICS:
Pediatric Care Recommendations for Freestanding Urgent Care Facilities

Committee on Pediatric Emergency Medicine

	ABSTRACT

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Freestanding urgent care centers are increasing as a source of after-hours pediatric care. These facilities may be used as an alternative to hospital emergency departments for the care and stabilization of serious and critically ill and injured children. The purpose of this policy statement is to provide recommendations for assuring appropriate stabilization in pediatric emergency situations and timely transfer to a hospital for definitive care when necessary.

Freestanding urgent care facilities remain a fixture in provision of health services in a managed care environment. Although the Academy does not approve of the routine use of urgent care facilities because it detracts from the medical home concept,^1,2 the use of these facilities as part of urgent and emergent care systems is increasing in the managed care environment. The term urgent care may imply to the public that a facility is capable of managing critical or life-threatening emergencies. Therefore, these facilities must have the capability to identify patients with emergency conditions, stabilize them, and provide timely access to definitive care should critically ill or injured children need care. Urgent care facilities must have appropriate pediatric equipment and staff trained and experienced to provide critical support for ill and injured children until transferred for definitive care. It is necessary for urgent care facilities to have prearranged access to comprehensive emergency services through transfer and transport agreements to which both facilities adhere. Available and appropriate modes of transport should be identified in advance.

When after-hours urgent care clinics are used as a resource for pediatric urgent care, they should solicit help from the pediatric professional community, and pediatricians should be accessible who are prepared to assist in the stabilization and management of critically ill and injured children. Pediatricians responsible for managing the health care of children may occasionally need to use the resources of urgent care facilities after hours. When such clinics are recommended to patients, pediatricians should be certain that the urgent care center is prepared to stabilize and manage critically ill and injured children.

	RECOMMENDATIONS

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Urgent Care Facility Emergency Preparedness

1. The provision of properly trained nursing and allied health personnel consistent with those required for a standby facility as defined by American Academy of Pediatrics guidelines for pediatric emergency care facilities.³
2. Have all necessary resuscitation drugs, equipment, and supplies as detailed in the "Guidelines for Pediatric Equipment and Supplies for Emergency Departments" from the Committee on Pediatric Equipment and Supplies for Emergency Departments, National Emergency Medical Services for Children Resource Alliance.⁴
3. Staffing by a physician with training, experience, and skills necessary for pediatric advanced life support.
4. Prearranged triage, transfer, and transport agreements with a definitive care facility that is capable of providing comprehensive care to ill and injured children.
5. A mechanism for notifying the primary care physician or another on call health care professional about the treatment given, and arranging for appropriate follow-up with the child's medical home.
6. An organized and structured quality improvement program that is consistent with the expectations for a standby facility for pediatric emergency care.³

Pediatrician's Role in Urgent Care Facilities

1. Monitor the quality of pediatric care provided by urgent care facilities used by his/her patients for after-hours care.
2. Ensure that the urgent care facility has been provided necessary clinical information, and be available to provide consultation when referring a patient.

If freestanding urgent care centers are properly staffed and equipped and have appropriate triage, transfer, and transport guidelines, the safety of children using these services for emergencies can be protected.⁵

COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE, 1998-1999
Robert A. Wiebe, MD, Chairperson
Barbara A. Barlow, MD
Ronald A. Furnival, MD
Barry W. Heath, MD
Steven E. Krug, MD
Karin A. McCloskey, MD
Lee A. Pyles, MD
Deborah Mulligan-Smith, MD
Timothy S. Yeh, MD

LIAISON REPRESENTATIVES
Richard M. Cantor, MD
  American College of Emergency Physicians
Dennis W. Vane, MD
  American College of Surgeons
Jean Athey, PhD
  Maternal and Child Health Bureau
David Markenson, MD
  National Association of EMS Physicians

SECTION LIAISONS
Joseph P. Cravero, MD
  Section on Anesthesiology
M. Douglas Baker, MD
  Section on Emergency Medicine
Michele Moss, MD
  Section on Critical Care
Dennis W. Vane, MD
  Section on Surgery

	FOOTNOTES

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

	REFERENCES

Top Abstract Recommendation References

1. American Academy of Pediatrics, Ad Hoc Task Force on Definition of the Medical Home The medical home. Pediatrics. 1992; 90:774 [Abstract/Free Full Text]
2. American Academy of Pediatrics, Ad Hoc Task Force on Definition of the Medical Home. The medical home statement addendum: pediatric primary health care. AAP News. November 1993
3. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine Guidelines for pediatric emergency care facilities. Pediatrics. 1995; 96:526-537 [Abstract/Free Full Text]
4. Committee on Pediatric Equipment and Supplies for Emergency Departments, National Emergency Medical Services for Children Resource Alliance Guidelines for pediatric equipment and supplies for emergency departments. Ann Emerg Med. 1998; 31:54-57 [CrossRef][Medline]
5. Zimmerman DR, Applebaum D Quality of pediatric care at a freestanding emergency facility. Pediatr Emerg Care. 1992; 8:265-267 [Medline]