Emergency Department

The healthcare provision for acutely unwell or injured children in the UK is changing fast. Paediatric emergency medicine (PEM) is now a recognised sub-speciality for Certification of Completion of Training for consultants in either Paediatrics or Emergency Medicine. Facilities for children in Emergency Departments (EDs) have improved since 2000 (following central government funding). At the same time the case-mix of children attending ED’s is changing, with less serious illness or injury, and more children with minor, self-limiting conditions being brought by parents and carers who find the lottery of primary care arrangements confusing, inaccessible or inadequate (particularly out-of-hours). Add to this the political changes which include the 4-hour emergency target, Modernising Medical Careers, the European Working Time Directive effects on doctors ’ rotas, continuing reconfiguration of services towards centralisation of specialist services (which affects EDs and paediatric units), and Payment by Results tariffs which can result in some perverse incentives around acute admissions to hospital, and we see a changing landscape