"More than one-third of the children taken to emergency departments in Houston and the surrounding 12-county area have urgent, emergent or critical needs and need to be transferred immediately to a facility that can provide a higher level of care," said Dr. Guy Clifton, Chief of Neurosurgery at Memorial Hermann Hospital. "Pediatric transfers frequently take two to four hours-precious time that can mean the difference between whether a child lives or dies."

Clifton is a founding member of Save Our ERs, a coalition that he co-founded to enlist public support for legislative action to address the emergency care crisis in Houston and the Gulf Coast Region. Save Our ERs' members include community leaders, prominent physicians and administrators from hospitals throughout Harris County, including noted trauma surgeon Dr. Red Duke.

The new study, "An Assessment of Pediatric Emergency Department Care Issues in the Houston Area," was funded by Save Our ERs and prepared by The Abaris Group, of Walnut Creek, California, a highly respected consulting firm that specializes in helping emergency departments and trauma centers nationwide solve problems ranging from ambulance diversion to financial and staffing shortfalls. Conclusions are based on responses to a survey sent to 54 hospitals in the 12-county area surrounding Houston with an 81 percent response rate.

The Abaris study notes a 14.1 percent increase in pediatric ED visits from 2001 to 2002. Hospitals reported that transferring pediatric patients to a facility capable of providing a higher level of care was the leading pediatric problem encountered in Houston-area emergency rooms. General Pediatric patients, those with an illness that is treatable and does not lead to a long-term disease, were identified as the most difficult patients to transfer, followed by children requiring treatment for trauma or injury. The primary reason for the transfer problem was the lack of pediatric bed availability. Only 13 of 43 responding hospitals stated that they accept pediatric transfers, and 41 percent of the hospitals said that children were at risk due to the lengthy time required to transfer them.

Almost 60 percent of the hospitals responding reported having no pediatric-specific ED treatment stations whatsoever, 43 percent have no pediatric in-patient beds and 82 percent have no pediatric intensive care unit beds. Forty percent of the Houston area's emergency departments state that only one-quarter or less of their nursing and/or ED physician staff have specific pediatric education/certification.

"Most EDs have taken steps to improve their pediatric care capabilities, but they are severely handicapped by circumstances that are beyond their control," said Clifton. "They are handicapped by the shortage of beds and pediatric staffing and the tremendous strain on their resources that is required to care for uninsured patients."

Save Our ERs commissioned the additional survey to better understand pediatric emergency care and patient transfer issues following an earlier study that identified children as one of the more difficult patient groups to transfer in this region.

"Freeing up hospital resources that now are being used to care for uninsured children would allow emergency departments to increase their pediatric beds and staffing, the two key problems cited by the facilities that responded to this survey," Clifton said. Increasing enrollment in the Children's Health Insurance Program (CHIP) and children's Medicaid would go a long way toward decreasing the burden of providing un-reimbursed care for pediatric patients in Houston's emergency rooms, he said.

Dr. Clifton also stressed the need for regional oversight of the Greater Houston area's emergency care system, endorsing the creation of a regional council to plan the future of the region's emergency care system. Such a council would adopt regional plans and policies for emergency and trauma care; establish standards; improve the coordination of services; pursue grant funds; serve as a conduit for state and federal funds; and study needs for the maintenance of services and improvements. Clifton said that emphasis would be placed on new technologies and region-wide coordination of communications.

"The emergency care crisis is a regional problem that demands a regional solution," said Clifton. "It is not 'someone else's problem,' it is everyone's problem. Potentially, every person in the 12-county area-particularly our children-may be affected directly if we don't resolve these issues and ensure our capability of handling all emergency care needs."