Children have specific anatomical, physiological, emotional, developmental and behavioural features that differ to those of adults. Thus, paediatric healthcare is provided differently to adult healthcare. Healthcare services have lagged in the provision of paediatric specific emergency care with many services combining both adult and children’s emergency care. In Brisbane, a new paediatric emergency department, supported by a short stay children’s ward, was established as a direct result of a political decision to close a tertiary children's hospital close by. This new paediatric emergency department was somewhat unique in that it stood alongside an adult emergency department in a large tertiary hospital. This new department provided the researcher with the opportunity to evaluate the paediatric emergency department from the perspectives of the end-users (staff and parents) and from the utilisation of the service. A comprehensive integrated literature review identified a paucity of research studies specifically evaluating a new health facility, especially a paediatric emergency department.
The aim of this program of research was to descriptively evaluate a new model of paediatric emergency department. Evaluation was considered from two main perspectives: users of the service (staff and patients) and utilisation of the service.
A multi methodology approach was employed in this study to enable triangulation to occur in order to evaluate the new emergency department phenomenon. The Donabedian Evaluation Framework guided the evaluation process for exploring this complex health service. Triangulation data were collected through multiple methods and from three different studies: 1. A qualitative exploration of staff transitioning from the adult emergency department to the paediatric emergency department; 2. A quantitative exploration of the paediatric emergency department throughput in the first two years post opening; and 3. A qualitative phenomenological inquiry into the lived experiences of the families who visited the paediatric emergency department with their sick or injured child.
Each study's data were analysed separately, then compared and integrated. Quantitative data were analysed using descriptive techniques, while qualitative data were analysed using thematic analysis.
For the first time, a descriptive evaluation of a new paediatric emergency department has been undertaken. The Donabedian Evaluation Framework provided the theoretical platform to evaluate the paediatric emergency department within the domains of structure, process and outcomes. All three studies produced results in these areas that offer an overall understanding of the paediatric emergency department. Findings in the domain of structure included several areas that were perceived by end users (families and staff) to enhance quality of care. These were: a specialised paediatric environment; staff expertise in paediatric and family-centred care, including skills, knowledge, and communication; and clear, professional and continuous organisational communication. Findings in the domain of process from the perspectives of end-users (families) that were perceived to contributed to enhanced health outcomes included: wait times; staff characteristics; treatment, presenting diagnosis; age of child and increased numbers of presentations. Findings in the domain of outcome included end-user (staff and families) perceived satisfaction of emergency services and new benchmarking emergency department data for children from birth to sixteen years of age. The results of the third study in particular provided insight into the care factor offered by the emergency department and its staff to the families who utilised it. The synthesis of findings from all three studies has revealed that the paediatric emergency department is providing appropriate emergency services to the greater population of north Brisbane and beyond.
This program of research evaluated a new model of paediatric emergency department services, providing emergent knowledge about the structure, process and outcomes of such a service, including findings related to human and physical resources, the service usage and throughput and the service function and healthcare delivery outcomes. It is an important program of research as there are no other studies that have evaluated a new paediatric emergency department model or the transition from an adult to a paediatric ED. As well, no other study has detailed the usage of a paediatric emergency department service across all ages of children from infants to adolescents. Paediatric emergency departments, whether specific or included within a general emergency department, have not previously been rigorously evaluated. This program of research has provided a set of comprehensive paediatric benchmarking data against which other paediatric emergency departments could compare their service for benchmarking purposes. These data have never been presented before, especially against the accepted paediatric age ranges and particularly for the middle adolescent (14 to 16 years) age group. These data provide a description of a well utilised and well-resourced paediatric specialty emergency department. This evaluation shows that because the paediatric emergency department is well appointed with paediatric focused resources (Structure: environment, staff and equipment), it has become well utilised while still meeting national emergency department targets and measures (Process and Outcome). Overall, this evaluation demonstrated a focused paediatric emergency department providing appropriate paediatric focused emergency care.
The key evaluation outcomes from this research program are suitable to use for informing current and future paediatric emergency department service providers regarding planning for a new paediatric emergency department, making the emergency department child and family friendly, and supporting staff with the transition to functioning within a new emergency department environment. These outcomes can be used by healthcare organisations in planning and redeveloping to strengthen the delivery of paediatric emergency department healthcare services, as well as benchmarking existing or new services. The outcomes of this program of research make a significant contribution to the identified knowledge gap surrounding the usage and evaluation of paediatric emergency department healthcare services.