EDAP or SEDP Renewal Application Forms
The following steps outline the application process for renewal of your status as an Emergency Department Approved for Pediatrics (EDAP) or Standby Emergency Department for Pediatrics (SEDP). Please note that completion of this application should be developed through interaction and collaboration with all appropriate disciplines within your facility.
- Review your current Emergency Department Approved for Pediatrics (EDAP) or Standby Emergency Department for Pediatrics (SEDP) Pediatric Plan.
- Using the EDAP & SEDP Renewal Pediatric Plan Checklist along with the Emergency Department Approved for Pediatrics requirements or Standby Emergency Department for Pediatrics requirements, complete an update to your previous EDAP or SEDP Pediatric Plan. Appendix all appropriate supporting documentation (schedules, policies, procedures, protocols, guidelines, plans, etc.).
- The Pediatric Plan should follow the Checklist format and include all supporting documentation including, but not limited to, scope of services/care, policies (both administrative and department specific), procedures, protocols, guidelines, flow charts, rosters, calendars, schedules, etc.
- Complete and obtain appropriate signatures on the Request for Re-Recognition of EDAP or SEDP Status signature form.
- Complete and obtain signatures on the following credentialing forms:
- Complete the Hospital Pediatric Preparedness Checklist
- Complete the Pediatric Equipment Checklist
- The Pediatric Plan should be submitted electronically as outlined by the EMSC Program.
- Submit one paper copy of your Pediatric Plan (with an original signed Application Form). Use one set of tabs provided by EMSC for the original signed copy. Submit single-sided and unstapled. Do not place pages in individual plastic sleeves. Each application must contain the following:
- Signed Request for Re-Recognition of EDAP or SEDP Status signature form.
- Completed EDAP and SEDP Pediatric Plan Checklist.
- Completed EDAP or SEDP Pediatric Plan, including supporting documentation.
- Completed Emergency Department Physician, Fast Track/Urgent Care Physician, Emergency Department Nurse Practitioner, Clinical Nurse Specialist and Physician Assistant, and Nursing credentialing forms, as applicable.
- Completed Hospital Pediatric Preparedness Checklist.
- Completed Pediatric Equipment Checklist.
- Maintain a copy for your files (using one set of tabs provided by EMSC).
- Submit these documents (including all supporting documentation) by the designated due date in the order listed to:
Division of EMS & Highway Safety
Illinois Department of Public Health
422 S. 5th St., 3rd Floor
Springfield, IL 62701
- Note that any submitted requests to waiver any of the EDAP or SEDP requirements must include the criteria by which compliance is considered to be a hardship and demonstrate how there will be no reduction in the provision of medical care.
- For questions regarding the application process, contact the EMSC Program at (217)785-2080 or DPH.EMSCProgram@illinois.gov.
Site Survey Procedure
- Within six to eight weeks following receipt of your updated Pediatric Plan and supporting documents, the hospital will be informed as to the status of the application. If all documentation is in order, a site visit will be scheduled.
- In preparation for the site visit, hospital personnel will prepare evidence to verify adherence to the facility recognition requirements.
- The site visit will include a survey of the Emergency Department, Pediatric Unit (including intensive care, if applicable, and any inpatient units where pediatric patients may be admitted) and a meeting with the following individuals:
- Hospital Chief Administrative/Executive Officer or designee
- Chief of Pediatrics, or if the hospital does not have a Pediatric Department, the designated pediatric consultant
- Administrator of Pediatric Services, if applicable
- Nursing Director and/or Nurse Manager, Pediatric Unit
- Administrator of Emergency Services
- Emergency Department Medical Director and/or the Pediatric Emergency Department Medical Director
- Emergency Department Nurse Manager and/or the Pediatric Emergency Department Nurse Manager
- Pediatric Physician Champion
- Pediatric Quality Coordinator
- Hospital Quality Improvement Department Director or designee
- Hospital Emergency Management/Disaster Preparedness Coordinator
- Nurse Practitioner, Clinical Nurse Specialist, and/or Physician Assistant representative for those facilities that utilize these practitioners in their Emergency Department
- For EMS Resource or Associate Hospitals only: EMS Medical Director and EMS Coordinator
Site Survey Team
The survey team will be defined by the EMSC manager, EMSC coordinator, and chief, IDPH Division of EMS & Highway Safety. Site survey teams will be composed of a physician/nurse team with at least one representative from the Illinois Department of Public Health. All team members will attend formal training in the site survey responsibilities, expectations, process, and assessment.
Following the Site Survey
- Within four to six weeks following the site visit, the hospital shall receive the results of the survey and may be requested to submit additional documentation. Those facilities meeting all requirements will receive a letter from the Illinois Department of Public Health formally renewing their EDAP or SEDP status.
- Hospitals that do not meet the requirements will receive a letter from the Illinois Department of Public Health outlining the areas of non-compliance. IDPH can deny a request for renewal of recognition if findings show failure to substantially comply with the EDAP or SEDP requirements. Hospitals may appeal the results of the survey by submitting a written request to the Illinois Department of Public Health, Division of EMS & Highway Safety.
- Re-recognition shall occur every four years, with site visits scheduled, as necessary.
- Withdrawal of recognition status may occur at any time, should a hospital fail to meet any of the requirements. In this situation, the hospital shall notify the Illinois Department of Public Health, Division of EMS & Highway Safety, at least 60 days prior to withdrawal and identify how area prehospital provider agencies, area hospitals, and the Illinois EMSC Office will be notified.
- EDAP or SEDP Renewal Application Packet
- EDAP and SEDP Renewal Pediatric Plan Checklist
- Request for Re-Recognition of EDAP or SEDP Status
- Emergency Department Physician Credentialing Form
- Fast Track/Urgent Care Physician Credentialing Form
- Emergency Department Nurse Practitioner/Clinical Nurse Specialist/Physician Assistant Credentialing Form
- Emergency Department Nursing Staff Credentialing Form
- Pediatric Equipment Requirements for Emergency Departments Checklist
- Hospital Pediatric Preparedness Checklist