273 Availability of Pediatric Emergency Care Coordinators in US Emergency Departments in 2018

Abstract

In 2007, the Institute of Medicine (IOM) recommended that every ED appoint pediatric emergency care coordinators (PECCs). PECCs focus on improving the quality of pediatric emergency care in their ED, which can include facilitating educational activities. Despite this recommendation, and its endorsement by multiple professional organizations (eg, ACEP), a national survey showed that 16% of general US EDs reported ≥1 PECC in 2015. Our objectives were to determine: the percent of US EDs with ≥1 PECC in 2018, factors associated with availability of ≥1 PECC in 2018, and changes in PECC prevalence between 2015 and 2018. In 2019, we conducted a survey of all US EDs to characterize emergency care in 2018. Using the National ED Inventory-USA database, we identified 5,514 EDs open in 2018. We mailed a brief survey to all ED directors up to three times and then contacted nonresponding EDs by phone to complete the survey by interview. Availability of a PECC was obtained with the question: “Do you have identified coordinators for pediatric emergency care in your ED?” Those that reported a PECC were asked to specify if they had a physician, nurse, or another type of PECC. A similar survey was administered to EDs in 2016 and identified availability of a PECC in 2015. Statistical analyses included chi-square and Wilcoxon-rank-sum tests as appropriate, and multivariable logistic regression models to identify factors independently associated with availability of a PECC in 2018 and addition of a PECC in 2018 versus 2015. Overall, 4,781 (87%) EDs responded to the 2018 survey. Among the 4,764 EDs with PECC data, ≥1 PECC was reported by 1,035 (22%). Specifically, 559 (12%) reported a physician PECC, 721 (15%) a nurse PECC, and 89 (2%) another type of PECC (eg, social worker). PECC prevalence varied widely by state. Three states (Connecticut, Massachusetts, and Rhode Island) had PECCs in 100% of EDs. States with the lowest percentage of EDs with PECCs were Mississippi (1%, 1/76 EDs), North Dakota (3%, 1/36 EDs), and Nebraska (3%, 2/71 EDs). In unadjusted analyses, compared with EDs without a PECC, EDs with ≥1 PECC were more likely to: have an annual total visit volume of ≥10,000, have a separate pediatric ED area, be in the Northeast, be in an urban area, and be academic (all P<0.001). They were less likely to be a freestanding ED or designated a Critical Access Hospital (P<0.001). In adjusted analyses, the factor most strongly associated with availability of a PECC in 2018 was an annual total visit volume of ≥40,000 compared to <10,000 (OR 4.89 [95% CI 3.53-6.78]).Overall, 84% of US EDs responded to the 2015 survey. The national PECC prevalence was higher in 2018 (22% of EDs) compared to 2015 (17%). The states with the greatest increase in the percent of EDs with ≥1 PECC between 2015 and 2018 were Massachusetts (+74%), Rhode Island (+67%), and Connecticut (+63%). EDs in the Northeast and with an annual total visit volume of ≥10,000 were more likely to first appoint a PECC by 2018 (all P<0.05). Despite the 2007 IOM recommendation that all US EDs appoint PECCs, the availability of ≥1 PECC in EDs remains low (22%), with little increase in national prevalence between 2015 and 2018. New England states report a high PECC prevalence, but more work is needed to appoint PECCs in most other US states. We will continue to monitor changes in PECC prevalence and work on further establishing the benefits of PECCs, including better understanding how PECCs can improve patient outcomes.