A new study is raising serious concerns about EDs that are not considered “pediatric ready” to manage emergencies involving children.

Investigators say critically ill children brought to these centers are three times more likely to die when compared with children in similar condition who are taken to hospitals with EDs that are well equipped to care for this age group.1

Investigators noted their findings provide the first evidence from multiple states that links the pediatric readiness of hospital EDs to care for critically ill or injured children with outcomes. Jennifer Marin, MD, MSc, emergency physician at UPMC Children’s Hospital of Pittsburgh and study co-author, notes that the definition of pediatric readiness is based on survey work from the National Pediatric Readiness Project (NPRP). (Editor’s Note: Take the readiness survey here: http://bit.ly/2nQ9rYu.) “The comprehensive 2013 survey of pediatric readiness among U.S. EDs was based on compliance with the 2009 national guidelines for pediatric care in the emergency department,” she explains. “Specific areas on which hospitals were measured in the survey included coordination of patient care, physician/nurse staffing and training, quality improvement activities, patient safety initiatives, policies and procedures, and the availability of pediatric equipment.” Hospitals received a pediatric readiness score from 0 to 100, with higher numbers indicating better preparedness to care for pediatric patients, Marin adds.

For the new study, investigators collected data from 426 hospitals in Florida, Iowa, Massachusetts, Nebraska, and New York relating to more than 20,000 pediatric patients who were brought to the ED. The investigators compared patient outcomes with the pediatric readiness of the specific hospital’s ED.

Based on pediatric readiness scores, the hospitals were divided into four groups. Those on the low end scored between 29.6 and 59; this group’s mortality rate for critically ill children was 11.1%. Conversely, hospitals at the high end scored between 88.2 and 99.9. This group’s mortality rate for critically ill children was 3.4%.

There are several steps that are important for EDs to take to properly care for children, according to Marin. These include making sure that weight-based measurements of all pediatric patients are in kilograms, instituting child-sized equipment protocols specific to pediatric patients, and putting plans in place to ensure rapid transfer to definitive care when applicable.

“All of these, as well as other components of pediatric readiness, should be overseen by a pediatric emergency care coordinator [PECC], a physician or nurse who is, in effect, a pediatric champion,” Marin observes. “In the NPRP survey, the presence of a PECC was shown to increase the likelihood of having all the recommended components for pediatric readiness.”

One of the criticisms of the pediatric readiness concept has been the lack of data showing that higher scores translate to better outcomes. The new findings are an important addition to the evidence base in this regard, Marin observes. “Specifically, we found a reduction in mortality for critically ill children treated at hospitals with a higher readiness score,” she says. “Although continued work is needed, including longitudinal analyses of their outcomes as they relate to a hospital’s readiness, this should provide hospitals with evidence to optimize their ability to provide emergency care for children.”

REFERENCE

  1. Ames SG, Davis BS, Marin JR, et al. Emergency department pediatric readiness and mortality in critically ill children. Pediatrics 2019;144(3).