Emergency Pediatric Readiness Improves Despite Challenges

Pediatric readiness in the US emergency departments (EDs) improved in most areas despite resource constraints imposed by the ongoing COVID-19 pandemic, highlights a recent survey by the National Pediatric Readiness Project (NPRP).

Led by the Emergency Medical Services for Children Program and conducted in collaboration with the American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association, the survey offers an insightful evaluation of the state of pediatric emergency care.

“We can’t treat children in emergency situations the same way we treat adults,” Kate Remick, lead author and co-director of the NPRP, said in a news release. “Every ED should have specialized knowledge, policies, and equipment, so they can meet children’s unique needs. With the ongoing pediatric mental health crisis and inpatient capacity challenges, high-quality emergency care for children is more important than ever,” Remick added.

The assessment used a 100-point scale to evaluate 5150 EDs across 59 states. More than 3557 EDs, representing approximately 14.1 million pediatric visits, completed the detailed survey encompassing diverse aspects of pediatric care, including administration, staffing, competencies, quality improvement, patient safety, policies, and equipment. The results were published in JAMA Network Open on July 7.

The median score was 69.5, which increased with annual pediatric patient volume. There was a slight but nonsignificant decrease in the adjusted median score from 2013 to 2021.

“Five of the six domains of pediatric readiness improved since the 2013 national assessment; however, there was a significant decrease in pediatric emergency care coordinators (PECC),” Marianne Gausche-Hill, study co-author and Medical Director at Los Angeles County EMS Agency, told Medscape Medical News.

The findings highlight the crucial role of PECCs in ensuring pediatric readiness, while also emphasizing the importance of physician and nurse PECC roles within EDs.

“Ideally a physician and a nurse PECC role needs to be codified within EDs to ensure day-to-day readiness and optimize patient outcomes. Quality improvement plans which include pediatric patients allow for a process which identifies variances in care, lack of education, or poor infrastructure that can be modified to further optimize pediatric outcomes. Finally, staffing the ED with board-certified emergency physicians and/or pediatric emergency physicians improves readiness through an ongoing commitment to continuing certification which is designed to include pediatric resuscitation content,” concluded Guasche-Hill.

The six domains for pediatric readiness are administration and coordination, personnel training and competencies, quality improvement plan, patient safety, policies and procedures, and equipment and supplies.

A decrease in the number of physician and nurse PECCs led to decline in the administration and coordination domain.

“During the pandemic, many pediatric inpatient services and pediatric-trained physicians and nurses were repurposed or transferred to adult units to care for patients with COVID-19. As our healthcare system normalizes post-COVID, we are hopeful that this workforce will be assigned to care for children in EDs and in inpatient pediatric units,” explained Guasche-Hill.

The presence of PECCs, along with pediatric-specific quality improvement plans, and the staffing of board-certified emergency medicine physicians were associated with increased pediatric readiness.

There were several notable improvements from the last assessment in some specific domains of readiness. The adoption of practices crucial for avoiding medication errors, including weighing and recording in kilograms only, increased from 67.7% to an encouraging 74.5%. Additionally, the implementation of pediatric mental health care policies rose from 44.1% to a remarkable 73.1%, underlining a growing awareness of the importance of addressing pediatric mental health concerns. The presence of pediatric quality improvement plans also rose from 45.1% to 50.0%.

The significance of pediatric readiness cannot be understated, especially considering that children constitute approximately 25% of ED visits in the United States. The 2018 joint statement on pediatric readiness by the American Academy of Pediatrics outlines the essential resources required for delivering high-quality emergency care. A robust pediatric readiness framework not only mitigates risks but also contributes to reducing both mortality and morbidity.

The study has some limitations, such as the dependence on self-reported data and potential reporting biases.

This study was funded by the US Department of Health and Human Services and Health Resources and Services Administration. The study authors reported no conflict of interest.

JAMA Network Open. Published online July 7, 2023. Full text

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