Child emergency services failing

One in four patients visiting A&E is a child

Many UK emergency services for children are failing to meet minimum standards set five years ago, say researchers.

A report in 1999 by expert groups made more than 30 recommendations on how A&E services needed to improve their care of children.

Now a review of 139 A&E departments around the UK shows many fall short on "child-friendly" services and training.

The authors from St Mary's Hospital, London, warn in the British Medical Journal that urgent action is needed.

There needs to be more investment in kids in casualty Report author Dr Ian Maconochie

A quarter of the emergency departments which responded to the survey did not have separate facilities for assessing a child as soon as they came in.

Of those that did have paediatric triage facilities, about a quarter did not use an appropriately trained nurse to carry out the assessment.

One of the recommendations by the intercollegiate group in 1999, which included the Royal College of Paediatrics and Child Health and the British Association of Accident and Emergency Medicine, was hospitals seeing more than 18,000 children should have a consultant in paediatric medicine by 2004.

But more than a third of the consultants working in A&E departments surveyed did not have specialist training in emergency paediatric care.

There were also shortfalls in training of other staff.

All emergency department staff should undertake refresher courses in paediatric life support, for example.

'Invest in kids'

Almost half of the nurses had not attended such training.

Lead author Dr Ian Maconochie said: "There needs to be more investment in kids in casualty.

"One in four patients that attend A&E are children.

"We found there were still shortages in trained staff and still a lack of child friendly facilities.

"If you can image what some departments are like on a Friday or Saturday night when children are brought in and can see distressed adults or intoxicated adults, it's not a very commodious environment."

Far from failing, children tend to receive the fastest service in A&E Department of Health spokeswoman

He acknowledged that the government was taking action to address the problem, but said: "It's something that does need further improvement."

Mr Martin Shalley, president of the British Association of Emergency Medicine, thought the findings were likely to be a fair representation of what was going on in UK hospitals.

He said: "There are not enough nurses anyway let alone anywhere near enough paediatric trained nurses. Many departments haven't got any."

He said recruiting and training more staff was important, but added: "We have to get the balance right to make sure that we still look after the two-thirds or more of our workload which are adults."

But he said the situation was beginning to improve.

'Fastest service'

Dr Alistair McGowan, president of the Faculty of Accident and Emergency Medicine, said: "We recognise that there is a need for concern.

"The situation is improving, but not as fast as we had hoped."

He said the expert group had applied for government funding to monitor progress of the standards year by year, but that the funding had been denied.

"We will try again," he said.

A spokeswoman from the Department of Health said: "Far from failing, children tend to receive the fastest service in A&E of any age group.

"However we are not complacent which is why we've a National Service Framework and training materials for NHS staff working with children.

"A checklist for the NHS on managing children in A&E is being issued in the New Year.

"We are also working with PCTs and the Royal Colleges to ensure that A&E departments have the best skill mix of healthcare staff dealing with children."