This is the current release of the guideline.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Injuries or illness requiring urgent care

Evaluation
Management

Critical Care
Emergency Medicine
Family Practice
Pediatrics

Allied Health Personnel
Nurses
Physicians

To provide updated and expanded recommendations for ensuring appropriate stabilization in pediatric emergency situations and timely and appropriate transfer to a hospital for definitive care when necessary

Critically ill and injured children

1. Ensuring freestanding urgent care facility emergency preparedness
2. Understanding pediatrician's role in freestanding urgent care facilities (referrals and providing consultation)

Not stated

Searches of Electronic Databases

Medline and PubMed were searched using keywords "urgent care centers" and "urgent care facilities;" articles or books identified by committee members.

Not stated

Subjective Review

Not applicable

Review

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

Not stated

Freestanding Urgent Care Facility Emergency Preparedness

1. Administrators at freestanding urgent care facilities should ensure that their staff is capable of providing resuscitation, stabilization, timely triage, and appropriate transfer of all pediatric patients.
2. Although the minimum standards for drugs, equipment, and supplies are listed in Tables 1 and 2 below, freestanding urgent care facilities with emergency medical systems response times of >10 minutes and transport times of >20 minutes to an emergency department need to have all suggested equipment, resuscitation drugs, and supplies as detailed in "Care of Children in the Emergency Department: Guidelines for Preparedness," issued jointly by the American Academy of Pediatrics (AAP) and American College of Emergency Physicians (AAP, 2001).
3. Freestanding urgent care facilities that provide care for children must be staffed by physicians, nurses, and ancillary health care professionals with the certification, experience, and skills necessary for pediatric basic and advanced life support during all hours of operation.
4. Triage, transfer, and transport agreements should be prearranged with definitive care facilities that are capable of providing the appropriate level of care based on the acuity of illness or injury of the child (AAP, 2000).
5. Mechanisms for notifying the primary care physician or another on-call health care professional about the treatment given to ensure appropriate follow-up with the child's medical home should be in place and should be compliant with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) (Pub L No. 101-191 [1996]). If a primary care physician is not identified, efforts should be made to refer the patient to a pediatrician able to promote a medical home environment.
6. Administrators at freestanding urgent care facilities must ensure that there is an organized and structured quality-improvement program to monitor and improve care for ill or injured children.
7. Freestanding urgent care facilities should have in place and should monitor compliance with policies, procedures, and protocols for emergency care of children consistent with those listed in "Care of Children in the Emergency Department: Guidelines for Preparedness" (AAP, 2001).
8. Freestanding urgent care facilities should have a policy for disaster preparedness and participate in their community disaster plan ("The pediatrician's role," 1997).

Table 1: Office Emergency Equipment and Supplies

* E indicates essential; S, strongly suggested (essential if emergency medical services response time is >10 minutes).

Table 2: Office Emergency Drugs

*E indicates essential; S, strongly suggested (essential if emergency medical services response time is >10 minutes).
**Metered-dose inhaler with spacer or mask may be substituted.

Pediatrician's Role in Freestanding Urgent Care Facilities

1. Pediatricians should refer patients for after-hours care only to freestanding urgent care facilities that have the capability to identify patients with emergency conditions, stabilize them, and arrange transfer for definitive care.
2. When referring a patient, the pediatrician should provide to the freestanding urgent care facility necessary clinical information and be available to provide consultation.

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

None provided

The type of evidence supporting the recommendations is not specifically stated.

• Appropriate stabilization of pediatric emergency patient in freestanding urgent care facilities and timely and appropriate transfer to a hospital for definitive care when necessary
• If freestanding urgent care centers are staffed and equipped properly and have appropriate triage, transfer, and transport guidelines, the safety of children using these services for emergencies can be protected.

Not stated

An implementation strategy was not provided.

Getting Better

Effectiveness
Timeliness

Not applicable: The guideline was not adapted from another source.

2005 Jul

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Pediatric Emergency Medicine

Committee on Pediatric Emergency Medicine, 2004-2005: Stephen E. Krug, MD, Chairperson; Thomas Bojko, MD; Margaret A. Dolan, MD; Karen S. Frush, MD; Patricia J. O'Malley, MD; Robert E. Sapien, MD; *Kathy N. Shaw, MD, MCSE; Joan E. Shook, MD, MBA; Paul E. Sirbaugh, DO; Loren G. Yamamoto, MD, MPH

Past Committee Members: Jane Knapp, MD, Past Chairperson; Ronald A. Furnival, MD; Daniel J. Isaacman, MD

Liaisons: Jane Ball, RN, DrPH, EMSC National Resource Center; Kathleen Brown, MD, National Association of EMS Physicians; Dan Kavanaugh, MSW, Maternal and Child Health Bureau; Sharon E. Mace, MD, American College of Emergency Physicians; David W. Tuggle, MD, American College of Surgeons

Staff: Susan Tellez

*Lead authors

Not stated

This is the current release of the guideline.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

None available

This NGC summary was completed by ECRI on July 27, 2005. The information was verified by the guideline developer on August 23, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.