Emergency departments (EDs) have made progress but still need to fully meet national guidelines for pediatric emergency care, despite the association with improved survival, found a study in JAMA Network Open.
The findings are based on a 2021 reassessment of EDs by the National Pediatric Readiness Project, a partnership of the Emergency Nurses Association, the American Academy of Pediatrics, and the American College of Emergency Physicians, led by the Emergency Medical Services for Children Program, part of the federal Health Resources and Services Administration.
“To treat children accurately in the ED takes not only specialized equipment but appropriate knowledge and policies,” says ENA President Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN. “It’s imperative that everyone in the ED is committed to improving pediatric care, especially with the ongoing pediatric mental health crisis and boarding issues.”
The assessment evaluates EDs on a 100-point scale. In 2021, 5,150 EDs were surveyed, with 3,647 responding and 3,557 available for full analysis. The median score was 69.5, which increased with annual pediatric patient volume.
The results largely indicate the progress from the last assessment in 2013, which was based on earlier guidelines.
“Comparing commonalities between the two assessments, we see improvement in five of six categories,” says Kate Remick, MD, the study’s lead author and co-director of the NPRP. “This is especially positive given EDs were navigating the pandemic at the time of the survey.”
But researchers say COVID-19 did contribute to a decline in one pivotal category: designating a nurse and physician – ideally both – as pediatric emergency care coordinators. EDs reporting physician and nurse PECCs decreased to 28.5% in 2021, a 13.5% drop.
“PECCs are a key driver of pediatric readiness,” says Hilary Hewes, MD, study co-author. “Unfortunately, the pandemic worsened widespread workforce shortages. Many EDs didn’t have resources to sustain the PECC role.”
As a result of the decline in this heavily weighted category, when comparing common data points, researchers say there was a slight decrease – 1.6 points – in adjusted median scores.
“The decrease is minor given the unique circumstances of COVID-19,” notes Marianne Gausche-Hill, MD, study co-author and NPRP co-director, who is considered a pioneer in pediatric readiness work. “The improvement in five of six categories despite these circumstances is most notable, reflecting high engagement of providers over the last eight years.”
Still, researchers point out the median falls below 88, the minimum score associated with marked improvements in survival. A 2019 study tied higher pediatric readiness to four-fold lower mortality in critically ill children.
To improve readiness, researchers emphasize the importance of designating PECCs. Implementing pediatric-specific quality improvement plans and staffing with board-certified emergency medicine physicians are also associated with score increases.
“We hope all EDs, regardless of volume, will prioritize these three components of pediatric readiness,” says Gausche-Hill. “The association of pediatric readiness with improved survival makes it a health care imperative.”
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