Illinois Administrative Code
Title 77 - PUBLIC HEALTH
Part 515 - EMERGENCY MEDICAL SERVICES, TRAUMA CENTER, COMPREHENSIVE STROKE CENTER, PRIMARY STROKE CENTER AND ACUTE STROKE READY HOSPITAL CODE
Subpart J - EMERGENCY MEDICAL SERVICES FOR CHILDREN
Section 515.4010 - Facility Recognition Criteria for the Standby Emergency Department Approved for Pediatrics (SEDP)
Current through Register Vol. 48, No. 12, March 22, 2024
a) Professional Staff: Physicians
All full and part-time emergency physicians caring for children in the emergency department or fast track/urgent care area shall have documentation of a minimum of 16 hours of continuing medical education (AMA Category I or II) in pediatric emergency topics every two years. CME hours shall be earned by, but not limited to, verified attendance at or participation in formal CME programs (i.e., Category I) or informal CME programs (i.e., Category II), all of which shall have pediatrics as the majority of their content. The CME may be obtained from a pediatric specific program/course or may be a pediatric lecture/presentation from a workshop/conference. To meet Category II, teaching time needs to have undergone review and received approval by a university/hospital as Category II CME. The Illinois Department of Financial and Professional Regulation can provide guidance related to criteria for acceptable Category I or II credit.
At least one physician meeting the requirements of subsection (a)(1), or a nurse practitioner, clinical nurse specialist, or PA meeting the requirements of subsection (b)(1), shall be on duty in the emergency department 24 hours a day or immediately available in person. A policy shall define when a physician is to be consulted orcalled in at times when the emergency department is covered by one of these clinicians.
Telephone consultation with a physician who is board certified or eligible in pediatrics or pediatric emergency medicine shall be available 24 hours a day. Consultation may be with an on-call physician or in accordance with Appendix M.
A backup physician, nurse practitioner, clinical nurse specialist, or PA whose qualifications and training are equivalent to that required by subsections (a) and (b) shall be available in person to the SEDP, within one hour after notification, to assist with critical situations, increased surge capacity or disasters.
Guidelines shall address response time for on-call physicians.
b) Professional Staff: Nurse Practitioner, Clinical Nurse Specialist and Physician Assistant
This subsection (b) pertains to nurse practitioners, clinical nurse specialists, and PAs working within their scope of practice, and credentialed as defined by the hospital.
c) Professional Staff: Nursing
At least one RN on duty each shift who is responsible for the direct care of the child in the emergency department shall successfully complete and maintain current recognition in one of the following courses in pediatric emergency care:
At least one RN on duty on each shift who is responsible for the direct care of the child in the emergency department shall have documentation of a minimum of eight hours of pediatric emergency or critical care continuing education every two years. Continuing education may include, but is not limited to, PALS, APLS or ENPC; CEU offerings; case presentations; competency testing; teaching courses related to pediatrics; and publications. The continuing education hours may be integrated with other existing continuing education requirements, provided that the content is pediatric specific. PALS, APLS and ENPC shall include both cognitive and practical skills evaluation.
d) Policies and Procedures
The hospital shall have policies/procedures addressing child abuse and neglect. These policies/procedures shall include, but not be limited to: the identification (including screening), evaluation, treatment and referral to DCFS of victims of suspected child abuse and neglect in accordance with State law.
The hospital shall have emergency department pediatric specific treatment guidelines, order sets or policies and procedures addressing initial assessment and management for its high-volume and high-risk pediatric population (i.e., fever, trauma, respiratory distress, seizures).
The hospital shall have a policy addressing the assessment of latex allergies and the availability of latex-free equipment and supplies.
The hospital shall integrate pediatric components into its Disaster Plan or Emergency Operations Plan.
e) Quality Improvement
The emergency department medical director shall appoint a physician to champion pediatric quality improvement activities. The pediatric physician champion shall work with and provide support to the pediatric quality coordinator.
A member of the professional staff who has ongoing involvement in the care of pediatric patients shall be designated to serve in the role of the pediatric quality coordinator. The pediatric quality coordinator shall have a job description that includes the allocation of appropriate time and resources by the hospital. This individual may be employed in an area other than the emergency department provided he or she has a minimum of 3600 hours of pediatric critical care experience or emergency department experience. Working with the pediatric physician champion, the responsibilities of the pediatric quality coordinator shall include:
f) Equipment, Trays, and Supplies See Appendix L.