A&E failures putting children’s lives at risk
A third of emergency departments not properly charting data designed to alert doctors to danger
CHILDREN attending Accident and Emergency are being put at risk because not enough hospitals are properly documenting their vital signs, a report has found.
The Royal College of Emergency Medicine (RCEM) said nearly one in three departments across the UK was failing to use a formal scoring system designed to alert doctors when children become gravely ill.
Young patients who arrive at Accident and Emergency with an illness, as opposed to an injury, are supposed to have their temperature, breathing, heart rate and other vital signs recorded within 15 minutes. Those who have abnormal vitals should have another full assessment within an hour.
The RCEM recommends that medical staff use the Paediatric Early Warning Scores system, or an equivalent early warning system, to record the re- sults. The college examined data for 16,000 children under 16 across 191 hospitals and found that the essential checks were not always being properly recorded. The report concluded “there is a need for increased documentation of both initial and repeat vital signs” within appropriate time frames.
Dr John Criddle, the chairman of the Royal College of Paediatrics, said: “Children make up nearly a quarter of total attendances at A&E and a significant proportion present with conditions such as fever, wheezing and breathing difficulties. Often, these conditions are dealt with quickly and easi- ly, but sometimes there can be underlying issues which can go unrecognised if vital signs are not recorded – sometimes with grave consequences.
“We therefore welcome the recommendations made by the RCEM in today’s report.”
Dr Cliff Mann, the RCEM president, said the study also highlighted the “clear need” for a “standardised scoring method that all clinicians can use”.
He said: “The audit shows that one third of children presenting to emergency departments are infants, those below two years old, who have limited ability to communicate symptoms and are therefore the most challenging. Paediatric emergency medicine is particularly challenging, because we know there will be a few very sick children amongst the many children with similar symptoms who have a self-limiting illness – the needles in the haystack.
“Standardised assessment and scoring methods can help clinicians spot the sick children but no tool is currently sufficiently sensitive or specific.”
The report comes after a Health Ombudsman review into the death of Sam Morrish, a three-year-old boy who died from septic shock, found a series of failings by health professionals.