Pediatric emergency care: Determinants and systematic barriers

Table 1 Summary of systemic barriers and proposed solutions for the quality of pediatric emergency care

Category	Key components
Quality indicators
Timeliness of care	Door-to-doctor time: Influenced by hospital size, staffing, triage[9,10]
	Time to treatment: Quick intervention improves survival[12]
	ED length of stay (LOS): It is an indicator of efficiency, and prolonged LOS could indicate ineffective therapy, bed shortages, or delayed diagnosis[13-15]
Patient safety	Adverse events include medication errors, misdiagnosis, and procedural mistakes[16-18]
	Root causes: Staff fatigue, poor communication, protocol non-adherence[20]
Diagnostic accuracy	Trauma: High misdiagnosis risk (e.g., abdominal injuries)[11]
	Sepsis: Early vague symptoms lead to delay[21]
	Respiratory issues: Misjudged severity impacts outcome[22]
Patient & family satisfaction	Influenced by communication, environment, and provider interaction[23]
	Family involvement improves satisfaction and treatment adherence[24]
Systemic barriers
Resource constraints	Lack of infrastructure[25,26]
	Poor staffing
	Lack of pediatric emergency physicians and protocols
Training gaps	Lack of specific pediatric training among ED practitioners
Outdated infrastructure	Outdated or ineffective infrastructure puts patient safety at risk and delays care[28]
	Lack of integrated care systems leading to delays in inpatient admissions, specialist consultations, and diagnostic testing
Proposed solutions
Telemedicine	To provide real-time support to rural and remote areas[30]
Mobile units	Helpful to stabilize children before transfer to a specialized hospital or to offer on-site care
Training	Structured pediatric emergency care training to ED members[31]
	Simulation-based trainings improve competence and confidence by enabling them to practice uncommon but crucial procedures under controlled conditions[33]
Clinical protocols	Use of protocols is helpful to standardize clinical practices
	Use in trauma/sepsis care has improved the outcome[32]
Research networks	Help improve the global standards and diagnostic accuracy
	PECARN: Helped to enhance the evidence-based practices for asthma, trauma, and sepsis
Artificial intelligence	Assists with the identification of critical cases using data analytics
	Promising early results in efficiency and safety
Quality improvement efforts	Focus on clinical protocols, early warning systems, and symptom-based training
	Effective in improving accuracy and reducing delays
Leadership role	Pediatric leaders drive QI, staff training, and policy adherence
	Leads to sustained pediatric care improvements

ED: Emergency department, PECARN: Pediatric emergency care applied research network; QI: Quality improvement.