Policy offers guidance for acute care services delivered outside the medical home
Susan J.Kressly, M.D., FAAP
While the Academy continues to assert that the pediatric medical home is the ideal
place for children to receive nonemergent acute care, accessibility, convenience and
market trends are leading families to seek out alternate settings. Within the framework
that all children deserve to have safe and appropriate care, the Academy brought together
pediatric stakeholders from different care settings to create the policy statement
Nonemergency Acute Care: When It’s Not the Medical Home.
The policy does not address acute care in the emergency department nor is it intended
to encourage patient/family use of these alternate venues.
It recommends that pediatricians create local and regional responses to increase appropriate
access to care for children in their communities and to work so that all care is safe
and of high quality. This may include innovative ways to offer extended hours, develop
integrated telehealth programs extending the medical home beyond the office walls
and working with appropriate pediatric resources in the community to ensure adequate
Wherever children access the health care system, there must be communication with
the medical home, according to the policy, which is available at https://doi.org/10.1542/peds.2017-0629 and will be published in the May issue of Pediatrics.
The policy emphasizes that to provide safe care, entities delivering acute care services
need to have an appropriate scope of practice that is aligned with their pediatric
expertise, and this information should be transparent to the community.
In addition, the policy states that retail-based clinics, telehealth services not
directly connected with the medical home and acute care services that lack pediatric
expertise should not provide care to children younger than 2 years. There are little data on delivery
of acute care services for children in these settings, and the policy outlines recommendations
for a research agenda so that evidence-informed guidance can be developed and adjusted
Core principles for delivery of acute nonemergent care outside the medical home include:
maximizing continuity with the medical home, including rapid communication;
providing care based on the best available evidence with clearly defined and transparent
limits of scope of service;
ensuring staff have pediatric training and experience to provide the scope of services;
establishing protocols for transitions of care during emergencies, after hours and
when care is outside the entity’s scope of service; and
implementing strategies for continuous assessment of quality of care and patient safety.
Patients and families deserve to know — from a trusted and transparent source — what
constitutes safe care for many common acute visits. An appendix to the policy excerpts
a page from HealthyChildren.org that advises parents on the basics of safe and evidence-based
care for common maladies, with links to selected guidelines. Pediatricians are encouraged
to share this information with families and care providers in their community.
The policy is from the AAP Committee on Practice and Ambulatory Medicine, Committee
on Pediatric Emergency Medicine, Section on Telehealth Care, Section on Emergency
Medicine Subcommittee on Urgent Care and Task Force on Pediatric Practice Change.
Dr. Kressly, a lead author of the policy, is a member of the AAP Task Force on Pediatric