title: Emergency department recognition program for pediatric services: does it make a difference?
abstract: OBJECTIVE
  This study aimed to determine if a pediatric emergency care facility recognition (PECFR) program improved care processes for injured children younger than 15 years.
  
  
  METHODS
  A controlled pre-post study design was used. Emergency department (ED) medical records were abstracted from 8 Delaware hospitals and 13 comparison hospitals in North Carolina in 2009 and again in 2013, 1 year after PECFR implementation. Data collected focused on pediatric processes of care, including vital sign assessment, pain assessment and management, treatment procedures, and diagnostic radiation.
  
  
  RESULTS
  A majority of 1737 children (97%) had an Injury Severity Score of 9 or lower. Both hospital cohorts significantly increased initial pain assessment documentation over time (P < 0001). For children with extremity immobilization and a pain score of 5 or greater, the interval between pain assessment and pain management was significantly shorter in the Delaware hospitals (P < 0.01) compared with hospitals from North Carolina. A significant reduction in radiation use (flat film and computed tomographic imaging) was also found in Delaware hospitals (P < 0001) compared with the hospitals in North Carolina.
  
  
  CONCLUSIONS
  Improvements in care to injured children associated with the PECFR program were limited to the interval between pain assessment and pain medication for children with extremity immobilization and to radiation use 1 year after the implementation of the PECFR program.
authors.affiliation: From the *Committee on Trauma, †American College of Surgeons, Chicago, IL; ‡University of Utah School of Medicine, Salt Lake City, UT, §Loyola University School of Medicine, Chicago, IL; and ∥Wake Forest University Health Sciences, Winston-Salem, NC.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Ball
authors.forename: Nels D
authors.initials: ND
authors.lastname: Sanddal
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Thomas
authors.initials: T
authors.lastname: Esposito
authors.forename: Milan
authors.initials: M
authors.lastname: Nadkarni
authors.forename: Ginger
authors.initials: G
authors.lastname: Wilkins
authors.forename: Wayne
authors.initials: W
authors.lastname: Meredith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003691:Delaware; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009657:North Carolina; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000592:standards; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement; D011829:Radiation Dosage; D014947:Wounds and Injuries / Q000628:therapy*