More Support Needed for Pediatric Emergency Care Coordinators
By Dorothy Brooks
Considering professional organizations view the pediatric emergency care coordinator (PECC) role as essential to pediatric readiness in U.S. EDs,1 there is concern about health system commitment to the role, based on the results of a survey of the physicians and nurses serving as PECCs.
Researchers conducted the assessment with a sampling of participants (114) from all regions of the United States who took part in the Emergency Medical Services for Children PECC Workforce and Trauma Collaboratives that took place in 2021 and 2022. Many respondents said they were not given enough time, training, or resources to carry out their PECC duties. Also, there were strong indications suggesting those serving as PECCs tend not to stay in these positions for long.2
For instance, although the survey respondents reported working in the ED for a median of 15 years, they spent a median of just one year serving in their PECC positions, explains Ashley Foster, MD, assistant professor of clinical emergency medicine at the University of California, San Francisco and the lead author of the assessment.
“Healthcare professionals [could be] leaving the medical workforce entirely, or, alternatively, leaving the ED environment for other areas of the healthcare system, either by choice or due to furlough,” Foster offers.
However, another possible explanation includes a lack of health system support for the PECC role, since 58.4% of respondents reported not having enough time to perform PECC activities. Only about one-third (32.4%) of respondents indicated they receive protected time for their PECC duties. Also, 70.8% indicated they would like to receive more PECC training and education, and 100% of respondents said they should be able to access state or regional conferences designed specifically for PECCs. However, 57.5% cited a lack of allotted time off as a barrier to obtaining additional pediatric training.
“Respondents identified multiple barriers, including a lack of resources including time, administrative support, and compensation,” Foster observes. Indeed, while 74.6% of respondents agreed the PECC role should be compensated, 30.7% reported the role in their ED was a voluntary position.
The researchers also found the amount of time per week respondents spent on PECC-related work differed significantly, based on pediatric volume in the ED. For example, in departments that see fewer than 1,800 children per year, PECCs spent a median of two hours per week on PECC activities.
Conversely, in EDs that see more than 10,000 children annually, PECCs spent a median of 16 hours per week on PECC-related activities. When asked about their assigned PECC responsibilities, the most common duties cited were education of staff (77.2%) and oversight of quality improvement work (72.8%).
“We believe that increased PECC support is a potential area of improvement for many healthcare systems,” Foster says. “The National Pediatric Readiness Project assessment in 2013 showed that the PECC role is associated with higher pediatric readiness for EDs, regardless of their annual ED pediatric volume category.”3
Foster says one way to bring attention to the importance of the PECC role is to amplify such data, demonstrating improved mortality rates in high pediatric-ready EDs vs. others.
While every ED has been urged to achieve pediatric readiness regardless of volume, Foster is concerned that a shift in pediatric-specific resources away from smaller community hospitals may jeopardize this goal, creating consequences for children in those areas.
“Additionally, given the rising capacity challenges [in children’s hospitals], particularly during respiratory surges, non-children’s hospitals and EDs may need to manage critically ill children for prolonged periods,” Foster explains. “Therefore, ensuring that every ED is prepared to care for children is vitally important, even if pediatric inpatient capacity has decreased within a hospital or health system.”
1. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, Emergency Nurses Association Pediatric Committee. Joint policy statement — guidelines for care of children in the emergency department. J Emerg Nurs 2013;39:116-131.
2. Foster AA, Li J, Wilkinson MH, et al. Pediatric emergency care coordinator workforce: A survey study. J Am Coll Emerg Physicians Open 2023;4:e13006.
3. Gausche-Hill M, Ely M, Schmuhl P, et al. A national assessment of pediatric readiness of emergency departments. JAMA Pediatr 2015;169:527-534.
Considering professional organizations view the pediatric emergency care coordinator role as essential to pediatric readiness in U.S. EDs, there is concern about health system commitment to the role, based on the results of a survey of the physicians and nurses serving in those positions.
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