Facility Categorization Toolkit

Hospitals and emergency departments are not all alike: in addition to basic services, individual facilities may also specialize in the provision of certain types of care or specific clinical conditions, i.e. stroke, trauma. The concept of categorizing healthcare facilities with regard to specialized capabilities and/or resources is not new, Early systems of pediatric care built upon categorization of facilities, as determined by resources and capabilities include, trauma and perinatal; both address high risk patient groups in which time critical diagnosis and treatment are essential and for which the needed specialty physicians, care, and resources are not readily available in all hospitals.

Categorization of Trauma, burn, perinatal, and stroke centers has existed for years. Categorization provides a mechanism whereby appropriate resources are determined to be readily available to provide optimal support and thereby optimal outcomes for high acuity, often low volume, time-sensitive diagnoses for patient groups requiring specialty care. Children are low volume specialty patients seen in all emergency departments but for which specialty services are not readily available.

Systems of care for children, built upon the categorization of facilities, were identified as important and first advocated for in the 1993 Institute of Medicine (IOM) report Emergency Medical Services for Children. Facility categorization is associated with developing a system of care or the notion of identifying available health resources within a given area and coordinating healthcare services to meet the needs of specific patient populations. The efficient use of resources through the categorization, integration, and coordination of emergency services, pre-hospital and hospital resources into one system assures that the larger emergency system is more efficient and can more effectively meet the needs of all children.

The 2006 Institute of Medicine (IOM) report Emergency Care for Children: Growing Painsalso supports the categorization of emergency care for children. Experts agree that a categorization system for hospitals capable of providing essential resources for children should have the following services in place:

  • pediatric-specific equipment;
  • caregivers (i.e. nurses and physicians) trained in pediatric emergency/resuscitation care;
  • pediatric-specific policies and protocols;
  • a system in place for monitoring pediatric care and performance improvement;
  • organized transfer processes, such as interfacility agreements and guidelines facilitating movement of pediatric patients and resources as necessary; and
  • processes to assure family integration

Note: The EMSC NRC developed separate toolboxes on Pediatric Equipment, Family-centered Care, and Interfacility Transfer. Please review these toolboxes for additional resources that may also apply to the broader term "facility categorization."