Implementation of a checklist to assist in the rapid identification of seriously ill children in the emergency department: an observational study

Abstract

Aim: Interventions are required to expedite the identification and treatment of seriously ill children in the emergency department (ED). The aim of this study was to test the hypothesis that the implementation of a features of serious illness in children checklist (FSIC) for ED nursing staff would be associated with a reduction in the presentation-to-treatment time (PTTT) among children who required hospital admission and active treatment.

Methods: An observational study was conducted 8 weeks before and 8 weeks after the implementation of the FSIC. The study was conducted in a busy combined adult and paediatric ED. Participants were children admitted to the hospital via the ED with a potentially life-threatening illness.

Results: A total of 3640 patients age less than 18 years attended the ED during the observation period. Of these, 214 patients met the eligibility criteria: 111 pre-FSIC and 103 post-FSIC. The overall ED workload and case-mix were similar during the two observation periods. The PTTT was on average 16% (95% confidence interval, 17-33%; P = 0.302) longer following the implementation of the FSIC.

Conclusion: The implementation of a checklist to assist ED nursing staff in the identification of seriously ill children was not effective in reducing the delay between presentation and the initiation of treatment among children who were admitted to the hospital. Larger studies are required to determine whether similar strategies are effective among a more critically ill subgroup. Consideration should also be given to alternative strategies to expedite the identification and treatment of seriously ill children in the ED.