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. 2023 Jul 3;6(7):e2321707.
doi: 10.1001/jamanetworkopen.2023.21707.

National Assessment of Pediatric Readiness of US Emergency Departments During the COVID-19 Pandemic

Katherine E Remick  1   2 , Hilary A Hewes  3   4 , Michael Ely  3   4 , Patricia Schmuhl  3   4 , Rachel Crady  3   4 , Lawrence J Cook  3   4 , Lorah Ludwig  5 , Marianne Gausche-Hill  6   7   8   9
Affiliations

National Assessment of Pediatric Readiness of US Emergency Departments During the COVID-19 Pandemic

Katherine E Remick et al. JAMA Netw Open. .

Abstract

Importance: The National Pediatric Readiness Project assessment provides a comprehensive evaluation of the readiness of US emergency departments (EDs) to care for children. Increased pediatric readiness has been shown to improve survival for children with critical illness and injury.

Objectives: To complete a third assessment of pediatric readiness of US EDs during the COVID-19 pandemic, to examine changes in pediatric readiness from 2013 to 2021, and to evaluate factors associated with current pediatric readiness.

Design, setting, and participants: In this survey study, a 92-question web-based open assessment of ED leadership in US hospitals (excluding EDs not open 24 h/d and 7 d/wk) was sent via email. Data were collected from May to August 2021.

Main outcomes and measures: Weighted pediatric readiness score (WPRS) (range, 0-100, with higher scores indicating higher readiness); adjusted WPRS (ie, normalized to 100 points), calculated excluding points received for presence of a pediatric emergency care coordinator (PECC) and quality improvement (QI) plan.

Results: Of the 5150 assessments sent to ED leadership, 3647 (70.8%) responded, representing 14.1 million annual pediatric ED visits. A total of 3557 responses (97.5%) contained all scored items and were included in the analysis. The majority of EDs (2895 [81.4%]) treated fewer than 10 children per day. The median (IQR) WPRS was 69.5 (59.0-84.0). Comparing common data elements from the 2013 and 2021 NPRP assessments demonstrated a reduction in median WPRS (72.1 vs 70.5), yet improvements across all domains of readiness were noted except in the administration and coordination domain (ie, PECCs), which significantly decreased. The presence of both PECCs was associated with a higher adjusted median (IQR) WPRS (90.5 [81.4-96.4]) compared with no PECC (74.2 [66.2-82.5]) across all pediatric volume categories (P < .001). Other factors associated with higher pediatric readiness included a full pediatric QI plan vs no plan (adjusted median [IQR] WPRS: 89.8 [76.9-96.7] vs 65.1 [57.7-72.8]; P < .001) and staffing with board-certified emergency medicine and/or pediatric emergency medicine physicians vs none (median [IQR] WPRS: 71.5 [61.0-85.1] vs 62.0 [54.3-76.0; P < .001).

Conclusions and relevance: These data demonstrate improvements in key domains of pediatric readiness despite losses in the health care workforce, including PECCs, during the COVID-19 pandemic, and suggest organizational changes in EDs to maintain pediatric readiness.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Weighted Pediatric Readiness Score by Emergency Medicine Board Certification, Presence of a Quality Improvement (QI) Plan, and Presence of a Pediatric Emergency Care Coordinator (PECC)
A, Emergency department staffing includes board-certified or eligible emergency medicine (EM) or pediatric emergency physicians (PEM) (only EM or PEM), some staff EM or PEM, and no staff EM or PEM. B, Emergency department has a QI plan that has all the components as outlined in national guidelines for care of children (full QI plan); has some of the components of the recommended QI plan (partial QI plan); no QI plan for children (no QI plan). C, Emergency department has both a physician and nurse PECC (MD and nurse PECC); has either a nurse or physician PECC (1 PECC); or has neither a physician nor a nurse PECC (No PECCs).
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References

    1. Institute of Medicine; Committee of the Future of Emergency Care in the U.S. Health System . Emergency Care for Children: Growing Pains. National Academy Press; 2006.
    1. EMS for Children Innovation and Improvement Center . National Pediatric Readiness Project. Accessed October 30, 2022. https://emscimprovement.center/domains/pediatric-readiness-project/about
    1. Remick K, Snow S, Gausche-Hill M. Emergency department readiness for pediatric illness and injury. Pediatr Emerg Med Pract. 2013;10(12):1-13. - PubMed
    1. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and American College of Emergency Physicians, and Pediatric Committee . Care of children in the emergency department: guidelines for preparedness. Pediatrics. 2001;107(4):777-781. doi:10.1542/peds.107.4.777 - DOI - PubMed
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