Regulatory policy

Hospital emergency departments lack a policy

Berlin, Germany: In a survey of emergency department staff across Europe, only around half said their hospital had a policy in place to help staff identify neglected or abused children.

The research, presented at the European Congress of Emergency Medicine [1]also shows that hospitals with such a policy are more likely to use strategies known to be effective in identifying abused children, including screening tools and staff training.

The study was presented by Féline Hoedeman, a doctoral student and medical student at the Erasmus MC Sophia Children’s Hospital in Rotterdam, the Netherlands. She said: “Abuse and neglect have devastating effects on children, families and society, but they can be very difficult to spot. Children who sustain abuse injuries are likely to present to emergency departments and previous research shows that staff can play an important role in identifying these children, especially if they have the training, tools and appropriate resources.

In collaboration with the Dutch Augeo Foundation, the European Society for Emergency Medicine (EUSEM), the European Pediatric Emergency Medicine Research Network (REPEM) and the European Society for Emergency Nursing (EuSEN), the researchers from Erasmus MC Sophia Children’s Hospital conducted a survey of healthcare professionals working in European emergency departments. Responses came from staff at 148 hospitals in 29 countries: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kosovo, Latvia, Lithuania, Malta. , Netherlands, Norway, Poland, Romania, Slovenia, Spain, Sweden, Switzerland, Turkey and United Kingdom.

Only 51% of respondents said their hospital had a standard child abuse policy. Twenty-four percent said they had no such policy. The remaining 25% did not know or did not say if they had a policy.

Those who said there was a policy were also more likely to say their hospital had a child maltreatment screening tool (52% versus 2% in hospitals without a policy), training on identifying abused children (63% vs. 30%), a child abuse team (73% vs. 27%), and a child abuse policy officer (51% vs. 20%). However, only 28% with a policy said their hospital used all four strategies.

The researchers caution that the responses came from individual professionals and are therefore not representative of all hospital staff.

Ms Hoedeman said: ‘Our study suggests there are some hospitals where the right steps are being taken to protect children. However, it also suggests that there are far too many hospitals where the child abuse and neglect policy is not in place or staff are unaware that the policy is there. When this is the case, staff are less likely to have the tools and knowledge they need and may miss opportunities to help vulnerable children.

The researchers plan to develop a toolkit, consisting of hospital policy, training and a screening tool, to help identify neglected or abused children. They have just completed a follow-up survey to investigate factors that could help or hinder the implementation of the toolkit.

Professor Youri Yordanov from the Emergency Department of St Antoine Hospital, APHP Paris, France, is Chairman of the EUSEM 2022 Abstracts Committee and was not involved in the research. He says, “We know that having structured protocols and processes in hospitals can reduce medical errors and benefit patients. This study claims that having a policy can help emergency department personnel identify at-risk children.

“Although regulations and legal systems differ between European countries, the essential elements of a hospital child abuse policy should always be in place and can be adapted to different hospitals. We are beginning to recognize that there is great variability between hospitals when it comes to recognizing child abuse and neglect and this is something that we urgently need to address.

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