Di Pietro P, Lattere M, Villa G, Piccotti E, D'Agostino P
U.O. P.S. Medico e Medicina d'Urgenza, DEA Pediatrico, Istituto Scientifico G. Gaslini, Genova, Italy.
Minerva Pediatr. 2005 Dec;57(6):399-409.
Because of the limited number of comprehensive paediatric centres, providing the entire continuum of paediatric care, including subspecialty care, and generally serving as regional referral centres for tertiary paediatrics, paediatric emergency care in Italy is often provided in adult facilities within primarily adult hospital institutions. Consequently, most paediatricians working in hospitals with a separate paediatric ward or department provide Emergency Department (ED) on-call coverage with serious liability concerns: such concerns are due to the fact that successful care of infants and children in an emergency situation requires appropriately sized equipment, well trained staff, appropriate and specialised triage and destination guidelines but, unfortunately, not all Italian facilities fulfil all these criteria. Risk management training of the entire ED staff may reduce the institution's involvement in malpractice litigation. Another useful tool within a paediatric ED is an Observation Unit (OU) for well-defined illnesses (such as asthma, croup, bronchiolitis, gastroenteritis, abdominal pain, mild dehydration, overdoses or poisoning, seizures), which can assure better patient's care, a decrease in missed diagnosis and acuity and decreased lenght of stay, and, consequently, a better risk management, decreased malpractice liability and cost effectiveness. Furthermore, in our paper we aimed to highlight the importance of aspects with a potential risk exposure in our profession, such as informed consent, exculpatory release forms, incident reports and complete ED record documentation of paediatric patients. In addition to that, the quality of care provided at ED in Italy has been assessed by analysing ED-related paediatric malpractice claims in the last 10 years. Finally, the importance of a joint commission within the Italian Paediatrics Society is underlined in order to discuss practice guidelines for paediatricians involved in emergency care.
由于综合性儿科中心数量有限，无法提供包括专科护理在内的完整儿科护理连续服务，且通常作为三级儿科的区域转诊中心，意大利的儿科急诊护理往往在主要为成人医院机构内的成人设施中提供。因此，大多数在设有独立儿科病房或科室的医院工作的儿科医生提供急诊科（ED）随叫随到服务，对此存在严重的责任担忧：这种担忧是因为在紧急情况下成功护理婴幼儿需要尺寸合适的设备、训练有素的工作人员、适当且专门的分诊和转诊指南，但不幸的是，并非所有意大利设施都满足所有这些标准。对整个急诊科工作人员进行风险管理培训可能会减少机构在医疗事故诉讼中的参与。儿科急诊科内的另一个有用工具是针对明确疾病（如哮喘、哮吼、细支气管炎、肠胃炎、腹痛、轻度脱水、用药过量或中毒、癫痫发作）的观察单元（OU），它可以确保更好地护理患者，减少漏诊和急症情况，缩短住院时间，从而实现更好的风险管理、降低医疗事故责任并提高成本效益。此外，在我们的论文中，我们旨在强调我们职业中具有潜在风险暴露的方面的重要性，如知情同意、免责声明表格、事件报告以及儿科患者完整的急诊科记录文件。除此之外，通过分析过去10年与急诊科相关的儿科医疗事故索赔，对意大利急诊科提供的护理质量进行了评估。最后，强调了意大利儿科学会内联合委员会的重要性，以便讨论参与急诊护理的儿科医生的实践指南。
