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Pediatric emergency services of the future.

The main problems facing emergency departments at present are: (a) the growing number of admissions, which has resulted from the use of emergency services for primary care and for repeat visits, largely for patient-perceived emergencies; and (b) patient noncompliance with follow-up care. Traditionally, hospital emergency services have been geared to handle mainly patients attending the facilities, but much emergency work is handled by telephone also, chiefly in the emergency department but sometimes in other hospital areas. A comprehensive pediatric emergency service should be equipped to handle quickly and expertly hospital transferrals, urgent and emergency cases, "walk-in" cases, phone calls from clinic patients and from the public, disaster management and physician consultation. This communication describes a conceptual organization of these facets of emergency services (Fig. 1). Pediatric emergency services of the future in a teaching hospital must be organized to deal efficiently with conditions perceived as emergencies by physicians or by patients. The services not only must be geographically appropriate but must incorporate a communications network. The medical information centre (MIC), which would provide this vital communications link, is usually neglected in most hospital emergency departments. Basically a telecommunication service, it would provide a wide range of emergency information to the public and to physicians. The MIC should be coordinated