Pediatric Community

  • 1.  Continuous Core Temperature Monitoring

    Posted 20 days ago

    In Florida, we recently passed pediatric readiness legislation and are currently awaiting the final standards. In the meantime, our hospital system has been proactively working to improve pediatric readiness across all facilities. During a recent PECC meeting, we were discussing education, policies, and equipment needs when the topic of continuous core temperature monitoring was raised. This was not something we had anticipated being included in the upcoming standards, so I was curious whether this is considered a necessary capability, particularly for our more rural, lower pediatric-volume hospitals.

    Our goal is to stabilize pediatric patients and transfer them to our pediatric hospital as soon as the need for higher-level care is identified. Given that approach, we are trying to better understand whether continuous core temperature monitoring would be expected or recommended in these settings.

    If you have any guidance on this topic, I would greatly appreciate your insights. Additionally, if your organization has any policies related to pediatric core temperature monitoring that you are willing to share, I would be grateful for the opportunity to review them.



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    Lauren Sanguinetti MSN, RN, CEN, CPEN, TCRN, CSPI
    Florida ENA President Elect
    Injury Prevention Outreach Coordinator
    Tampa, FL
    LSanguinetti03@yahoo.com
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  • 2.  RE: Continuous Core Temperature Monitoring

    Posted 10 days ago
    Hi, Lauren,

    If I understand your question correctly, you are asking whether continuous core temperature monitoring is a necessary capability or expected standard for emergency departments under Florida's new pediatric readiness legislation. 
    The short answer to that is no. Continuous core temperature monitoring is not a mandated baseline requirement for emergency department pediatric readiness under Florida's recently passed Health Care Patient Protection Act (CS/HB 355) or the updated National Pediatric Readiness Project (NPRP) guidelines. The Agency for Health Care Administration (AHCA) standards being developed in Florida in response to the legislation may focus heavily on pediatric vital sign protocols, but the specific national baseline standard outlined in the Joint Pediatric Readiness in the Emergency Department: Policy Statement from AAP for equipment requires a thermometer with low-temperature capabilities rather than a continuous core monitoring system. https://publications.aap.org/pediatrics/article/157/2/e2025075318/206126/Pediatric-Readiness-in-the-Emergency-Department?autologincheck=redirected
    This is also reflected in the NPRP Pediatric Readiness ED Checklist https://emscimprovement.center/domains/pediatric-readiness-project/readiness-ED-checklist/
    For rural, lower pediatric-volume hospitals centered on stabilization and transfer, implementing full continuous core temperature monitoring across the board is generally considered an advanced clinical capability rather than a mandatory baseline requirement.
    There may be need for clarification due to the content of the Joint Statement on Policies, Procedures, and Protocols for the ED which states "Documentation of a full set of pediatric vital signs, including core temperature, respiratory rate, pulse oximetry, heart rate, blood pressure (including manual confirmation), pain, and mental status when indicated". In this case, 'core temperature' means one time in triage, not as a continuous modality. Current guidelines define a rectal temperature as the clinical gold standard for establishing true core temperature unless strictly contraindicated for infants and children under three years of age requiring critical stabilization. (This may change in the near future due to current research).
    For now, consensus guidelines state that core temperature should be considered and re-evaluated when clinically indicated (e.g., severe sepsis, major trauma, resuscitation, or exposure). Continuous monitoring via rectal or esophageal probes is typically reserved for critical care, advanced therapeutic cooling/warming, or prolonged boarding, rather than short-term stabilization prior to transfer. In Florida, this currently applies until we see what standards AHCA may develop. The law explicitly directs AHCA to draft the definitive rules in consultation with the Florida Emergency Medical Services for Children (EMSC) State Partnership Program (administered by the University of Florida College of Medicine – Jacksonville). As you are aware, I am a member of the Advisory Committee to that program. I believe I can confidently say the members of that committee understand expecting hospitals to meet a standard which requires continuous core temperature monitoring for pediatric patients outside of critical care settings is unrealistic.
    Hope this helps but reach out if you need any references.

    Penny