Updated assessment of pediatric readiness of emergency departments

Pediatric readiness at emergency departments (EDs) throughout the United States appears to have improved based on self-reported online assessments of compliance with national guidelines, according to an article published online by JAMA Pediatrics.

The importance of EDs maintaining a state of readiness to care for children cannot be overemphasized because day-to-day readiness affects disaster planning and response and patient safety. The Emergency Nurses Association joined the American Academy of Pediatrics and the American College of Emergency Physicians in cosponsoring pediatric readiness efforts. Those professional organizations, along with the federal Emergency Medical Services for Children (EMSC) program of the Health Resources and Services Administration, formed a national coalition to target improvements. In 2011, a national steering committee of these stakeholders assembled to implement a public health initiative to address the previously reported disparate state of pediatric readiness of EDs. The first step of the initiative was a 55-question web-based assessment of ED readiness for children, as measured by compliance with 2009 national guidelines, according to the study background.

Marianne Gausche-Hill, M.D., of Harbor-University of California, Los Angeles, Medical Center, and coauthors report on ED readiness based on the web assessment with responses from 4,137 EDs, which were included in the analysis and represent about 24 million annual pediatric ED visits.

The study results indicate a median weighted pediatric readiness score (WPRS) of 68.9, an improvement and increase from a previously reported WPRS score of 55.

The WPRS score varied by pediatric patient volume with low-volume EDs having a median WPRS of 61.4; medium-volume EDS, 69.3; medium-to-high volume EDs, 74.8; and high-volume EDS, 89.8.

Of the 4,137 EDs that responded, 1,966 (47.5 percent) reported a physician pediatric emergency care coordinator (PECC), 2,455 EDs (59.3 percent) reported a nurse PECC and in 1,737 EDs (42 percent) there were both types of PECCs, according to the results.

The results also show that lower-volume hospitals reported a higher percentage of family medicine-trained physicians caring for children (78.9 percent) compared with high-volume hospitals (32.1 percent), where most physicians caring for children were trained in emergency medicine or pediatric emergency medicine.

Nearly all the EDs (99.5 percent) reported staff were trained on the location of pediatric equipment in the ED, but only 45.1 percent of the EDS reported having a quality improvement plan addressing the needs of children. Also, only 46.8 percent of EDs reported having a disaster plan that addresses children, according to the study.

Many EDs (80.8 percent) reported barriers to implementing readiness guidelines, including the cost of training (54.4 percent) and a lack of educational resources (49 percent), the results show.

"These data demonstrate improvement in pediatric readiness of EDs compared with previous reports. The PECCs play an important role in ensuring pediatric readiness of EDs and barriers may be targeted for future initiatives. We describe the successful implementation of a comprehensive assessment by a national coalition that achieved a high response rate and is poised for further engagement with the goal to ensure day-to-day pediatric readiness of our nation's EDs," the study concludes.

(JAMA Pediatr. Published online April 13, 2015. doi:10.1001/jamapediatrics.2015.138. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: This project is supported by a grant for Emergency Medical Service (EMS) for Children network development and by a grant for EMS for Children National Resource Center from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). Please see article for additional information, including other authors, author contributions and affiliations, etc.

In a related editorial, Evaline A. Alessandrini, M.D., M.S.C.E., of Cincinnati Children's Hospital Medical Center, and Joseph L. Wright, M.D., M.P.H., of the Howard University College of Medicine, Washington, write: "Improvement is surely the main reason to measure pediatric readiness of our nation's EDs. Performance measures are yardsticks by which all health care professionals and organizations can determine how successful they are in pediatric readiness, delivering recommended care and improving patient outcomes."

"However, there are other important purposes of performance measurement. Transparently reporting pediatric ED readiness scores to patients and the public holds health care professionals accountable to both consumers and purchasers of care; transparency builds trust. Patients can also learn what the expected professional standards of care are and where they can go to receive them," the editorial continues.

"There is still a long way to go, however, and the National Pediatric Readiness Project certainly brings the field closer to a full-circle realization of the evidence parameters around which universal standards for the care of children in EDs can be implemented and ultimately linked to optimal outcomes," the authors conclude.

(JAMA Pediatr. Published online April 13, 2015. doi:10.1001/jamapediatrics.2015.0357. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see article for additional information, including other authors, author contributions and affiliations, etc.

###

Media Advisory: To contact corresponding author Marianne Gausche-Hill, M.D., call Laura Gore at 202-370-9290 or email lgore@acep.org. To contact corresponding editorial author Evaline A. Alessandrini, M.D., M.S.C.E., call Jim Feuer at 513-636-4656 or email Jim.Feuer@cchmc.org.