Pediatric Emergency Care Coordinator Research Articles

Evaluation of a Nurse Pediatric Emergency Care Coordinator–Facilitated Program on Pediatric Readiness and Process of Care in Community Emergency Departments After Collaboration With a Pediatric Academic Medical Center

Each year, more than 30 million ill and injured children are cared for in 5,000 emergency departments in the United States, of which most children access care in 1 of 4,500 community emergency departments (CEDs) that are not solely prepared to care for children.1,2 These CEDs vary in terms of the total volume of pediatric patients where many of them care for fewer than 5 children a day. In 2006, the Institute of Medicine described pediatric emergency care in the US as “uneven.”3 In response to this report, key stakeholders—including the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association—developed Joint Policy Statement Guidelines (JPSG) for the emergency care of children.

Closing the Loop: Program Description and Qualitative Analysis of a Pediatric Posttransfer Follow-up and Feedback Program.

Follow-up and feedback foster improvement. General emergency medicine providers working in community hospitals desire follow-up and feedback on pediatric patients transferred to children's hospitals. We implemented a novel program to provide these data to our colleagues. The objective of this study was to explore stakeholder perspectives of our program. We provided secure, electronic reports on transfers from 7 general emergency departments (GEDs). Patient follow-up and feedback data were delivered to the GED's pediatric emergency care coordinator. Seven pediatric emergency care coordinators and 2 children's hospital liaisons participated in semistructured interviews. Five researchers coded and analyzed transcribed data using the constant comparative method of grounded theory. Codes were refined and clustered to develop themes. Perceived values of the program included GED appreciation of closing the loop on transferred patients, providing education, and informing quality improvement. Participants valued the concise and timely nature of the reports and their empathetic delivery. Facilitators of program implementation included established professional relationships between the GED and the children's hospital liaisons and a GED's culture of self-inquiry. Barriers to program implementation included potential medicolegal exposure and the time burden for report generation and processing. Suggested programmatic improvements included focusing on generalizable, evidence-based learning points and analyzing care trends. Stakeholders of our pediatric posttransfer follow-up and feedback program reported many benefits and provided key suggestions that may promote successful dissemination of similar programs nationwide. Examining data trends in transferred children may focus efforts to improve the care of children across all emergency care settings.

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

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.

Characteristics Associated With Presence of Pediatric Mental Health Care Policies in Emergency Departments.

The majority of US children do not have access to an emergency department (ED) with a pediatric mental health care policy in place. Our objective was to understand factors associated with whether US EDs have a pediatric mental health care policy. We analyzed data from the National Pediatric Readiness Project, a nationally representative cross-sectional survey of US EDs. Nurse managers reported whether their hospitals had a policy to care for children with social/mental health concerns (n = 3612). We calculated prevalence estimates, prevalence ratios (PRs), and confidence intervals (CIs) for regional and ED characteristics (eg, rurality and types of personnel) by whether EDs had a pediatric mental health care policy. Overall, 46.2% (n = 1668/3612) of EDs had a pediatric mental health care policy. Emergency departments located in remote areas were 60% less likely to have such a policy compared with EDs in urban areas (PR, 0.4; CI, 0.3-0.5). Emergency department characteristics associated with having a pediatric mental health care policy included having a policy to transfer children with social/mental health concerns (PR, 5.4; CI, 4.7-6.2), having a policy to address maltreatment (PR, 3.4; CI, 2.6-4.4), and having nurse and physician pediatric emergency care coordinators (PR, 1.6; CI, 1.5-1.8). Lower prevalence of pediatric mental health policies in rural EDs is concerning considering EDs are often the first point of contact for pediatric patients. This work highlights the importance of pediatric emergency care coordinators in fostering ED capacity to meet children's mental health needs.

13 Assessing Proximity Effect of High-Acuity Pediatric Hospitals on the Pediatric Readiness Scores of Neighboring Nonpediatric Emergency Departments

To determine if there is a proximity effect of high-acuity pediatric hospitals (HAPH) on the weighted pediatric readiness score (WPRS) of neighboring non-pediatric hospitals; to determine if this effect can be attributed to any specific components of the National Pediatric Readiness Guidelines. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) of US emergency departments based on the 2013 National Pediatric Readiness Project (NPRP). High-acuity pediatric capable hospitals (HAPH) were defined as those with a pediatric ICU, pediatric ward, and a neonatal ICU. Non- pediatric hospitals within a 30-minute drive time of a HAPH were defined as neighboring hospitals. All analysis was based on annual pediatric volume; low, <1800, medium, 1800-4999, medium-high, 5000-9999, high >10,000. We analyzed components of the readiness guidelines including QI/Safety Initiatives, pediatric emergency care coordinator (PECC) and availability of pediatric-specific equipment. Groups were compared using the Wilcoxon rank-sum test with p-values <0.05 as significant. A total of 3,933 non-pediatric hospitals were identified, 1,009 within a 30-minute drive to a HAPH. Non-pediatric hospitals within a 30-minute drive from a high acuity pediatric hospital had a statistically significant higher mean WPRS across all pediatric volumes. (Table 1). Neighboring hospitals were more likely to have a PECC, a policy regarding informing abnormal pediatric vital signs, and critical pediatric equipment. Non-pediatric hospitals within a 30-minute drive time of HAPH have a higher overall WPRS than more distant hospitals. These results may indicate a target area for outreach by state and national partners to improve pediatric readiness in non-pediatric emergency departments.Table 1WPRS by volume and proximity to HAPHOverall (N=3933)<30 minutes to HAPH (N=1009)>30 minutes to HAPH (N=2924)P-valueLow (N)16252611364Mean WPRS (SD)61.9 (16.18)66.7 (18.06)61 (15.63)<0.0011Medium (N)1241312929Mean WPRS (SD)69.7 (15.81)73.8 (16.04)68.3 (15.5)<0.0011Medium-High (N)697257440Mean WPRS (SD)73.6 (16.45)77.1 (16.17)71.6 (16.28)<0.0011High (N)370179191Mean WPRS (SD)79.0 (16.42)81.1 (15.80)77.1 (16.79)0.02911 Wilcoxon rank-sum test Open table in a new tab

National Study of Self‐reported Pediatric Areas in United States General Emergency Departments

While many U.S. emergency departments (ED) have a "pediatric ED," there are, to our knowledge, no accepted criteria for this type of ED. We investigated the prevalence, distribution, staffing, and characteristics of self-reported pediatric areas in U.S. general EDs. We conducted a survey of all 5,273 U.S. EDs to characterize emergency care in 2015. We then surveyed 130 of the 426 general EDs who reported having a pediatric area. Data collection for the second survey included confirmation of a pediatric area and information on that area's structure and staffing. The national survey (85% response) showed 10% of general EDs reported a pediatric area. Only 16% of all U.S. EDs had a pediatric emergency care coordinator (PECC). EDs with larger visit volumes, or in the Northeast or South, were more likely to have a pediatric area. Nine states had no general EDs with pediatric areas. Among general EDs with a pediatric area, 75% had a PECC and 74% had a board-certified or board-eligible pediatric emergency medicine (PEM) physician on staff. Ninety-three percent had designated pediatric beds. Rarely (3%) was the pediatric area just a separate waiting area within a general ED, without any PECC or PEM physician present. We found that 10% of U.S. general EDs had a pediatric area and that this prevalence varies nationwide. Moreover, only 16% of U.S. EDs had a PECC. Further studies on the impact of ED structure and staffing on pediatric care and patient outcomes are urgently needed. As a long-term objective, a standardized definition of a pediatric ED would not only help quality improvement efforts but also help families make more informed choices about where to bring their children to receive care.

Pediatric Readiness in Critical Access Hospital Emergency Departments.

Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care. The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS). A WPRS of 100 indicates that the ED meets essential guidelines for pediatric readiness. Using descriptive statistics, we also compared low (fewer than 5 children a day) and medium patient volume (5-14 children a day) EDs in 6 core areas of readiness. Eighty-six percent (1,140) of CAHs were linked to the NPRP. In the study, 80% were low and 20% medium volume. The median WPRS was 59.0 for low and 67.3 for medium volume. While some differences were found by patient volume, overall 63% of CAHs had a pediatric emergency care coordinator, 34% had a pediatric patient care review process, 62% had interfacility transfer guidelines, and 45% weighed children only in kilograms. CAHs participating in a facility recognition program had significantly higher median WPRS scores (84.3) compared to those not participating (59.5). CAHs have challenges in being ready to care for children in the areas of pediatric emergency care coordinators, policies, procedures, and patient safety. Minimal cost interventions are available to increase the readiness of CAHs to care for children.

Novel Approach to Emergency Departments' Pediatric Readiness Across a Health System.

A gap analysis of emergency departments' (EDs') pediatric readiness across a health system was performed after the appointment of a service line health system pediatric emergency medicine (PEM) quality director. A 55-question survey was completed by each eligible ED to generate a weighted pediatric readiness score (WPRS). The survey included questions regarding volume, ED configuration, presence of a pediatric emergency care coordinator (PECC), quality initiatives, policies and procedures, and equipment. Surveys were completed from June 1 to November 12, 2016.Analysis of variance was used to compare the 4 groups of EDs based upon their annual pediatric volume as a continuous measure (low, <1800 visits; medium, 1800-4999 visits; medium-high, 5000-9999 visits; high, >10,000 visits). The Fisher exact test was used to compare the 4 groups for the remaining categorical variables represented as frequencies and percentages. A result was considered statistically significant at the P < 0.05 level of significance. There were a total of 16 hospitals (after the exclusion of the children's hospital, the hub for pediatric care in the health system, and 1 adult-only hospital) with the following pediatric capability: 7 basic (no inpatient pediatrics), 7 general (inpatient pediatrics, with/without a neonatal intensive care unit), and 2 comprehensive (inpatient pediatrics, pediatric intensive care unit, and a neonatal intensive care unit). In 12 EDs, adults and children are treated in the same space. These EDs see a total of 800,000 annual visits including 120,000 pediatric visits. Two low pediatric volume EDs had a median WPRS of 69, range of 62 to 76 (national median, 61.4); 6 medium pediatric volume EDs had a median WPRS of 51, range of 42 to 81 (national median, 69.3); 4 medium-high pediatric volume EDs had a median WPRS of 69.3, range of 45 to 98 (national medium, 74.8); 4 high pediatric volume EDs had a WPRS score of 84.5, range of 58 to 100 (national medium, 89.8). There were 4 sites with PECCs: 1 medium-high volume and 3 high volume, with a median WPRS of 98.5, range of 81 to 100 (national medium, 89.8). Two low-volume EDs have Neonatal Resuscitation Program training for nurses (P < 0.0083). One medium-high volume ED requires specific pediatric competency evaluations for advanced level practitioners staffing the ED. Pediatric-specific quality programs are present in the 2 low volume EDs, 3 of the 6 EDs in the medium group, 3 of 4 EDs in the medium-high group, and all 4 high volume hospitals. After the implementation of the health system PEM quality director, all EDs have a doctor and nurse PECC with a median WPRS of 81. In additiona, a committee was formed with the following key stakeholders: PECCs, pediatric nursing educators, pediatric quality, pharmacy, obstetrics, behavioral health, and neonatology. The committee is part of the health system quality program within both pediatrics and emergency medicine and is spearheading the standardization of code carts and medications, dissemination of pediatric clinical guidelines, and the development of a pediatric quality program across the health system. Pediatric emergency care coordinators play an important role in ED readiness to care for pediatric patients. In a large health system, a service line PEM quality director with the support of emergency medicine and pediatrics, a committee with solid frontline ED base, and a diverse array of stakeholders can foster the engagement of all EDs and improve compliance with published guidelines.

191 Evaluation of Interventions to Improve Pediatric Readiness in Community Emergency Departments: A Mixed Methods Study

In 2009 the American College of Emergency Physicians, American Academy of Pediatrics, and Emergency Nurses Association jointly published guidelines for pediatric readiness for all emergency departments (EDs). In 2012-2013, the National Pediatric Readiness Project completed a Web-based assessment of EDs, generated a weighted pediatric readiness score (WPRS) based on compliance with the published guidelines, established a baseline of pediatric readiness in the United States, and provided individual EDs with a roadmap for improvement. Our goals were to engage a large health care system, to assess the effect of multi-faceted interventions aimed at improving pediatric readiness, and to perform a qualitative evaluation to identify components of the interventions that were thought to be most influential. We performed a mixed methods study using a “before-after” framework among 19 EDs in the Kaiser Permanente Northern California (KPNC) health care system. Each ED was assessed at baseline (in 2012) using the WPRS, a scale ranging from 0 - 100, then re-assessed (in 2015) following various ED-specific and regional interventions to improve readiness. Semi-structured interviews were then performed with emergency physician leaders from each institution. Interviews were recorded, transcribed, and examined for themes using a structured qualitative analysis. Nineteen EDs completed both the 2012 and 2015 assessments with a median WPRS of 70.0 in 2012 and a median WPRS of 77.8 in 2015 (difference=+7.8, p=0.09). Of the 19 EDs, 12 (63%) improved > 5 points, 4 (21%) EDs declined > 5 points, and 3 (16%) remained within a 5 point range. Mean improvement was +7.7 points (95% CI -1.3, 16.7). Mean changes in WPRS by domain of pediatric readiness were: policies and procedures + 4.4 (95% CI 1.4, 7.4); quality improvement activities + 2.3 (95% CI -0.1, 4.6); pediatric emergency care coordinators +2.0 (95% CI -3.2, 7.2); equipment + 0.7 (95% CI -0.7, 2.1); staffing and training -0.5 (95% CI -2.1, 1.1); and patient safety initiatives - 1.2 (95% CI -2.1, -0.2). Semi-structured interviews were conducted with physician leaders from 9 of the 19 EDs, 6 with increased WPRS, 2 with decreased WPRS, and 2 with no change in WPRS. Eight out of nine physician leaders reported the WPRS was an accurate reflection of their ED’s pediatric readiness. Common themes from the interviews included: (1) the national survey in 2012 brought attention and administrative buy-in to the issue of pediatric readiness; (2) many pediatric readiness improvement activities were initiated by ED nursing; and (3) both an ED pediatric champion and collaboration with inpatient pediatrics were key to improvement. Examples of activities that physician leaders reported improved the care of children between the 2012 and 2015 assessments included: pediatric simulation, use of critical care telemedicine, formalizing transfer agreements, equipment checks, disaster drills, and the use of a weight-based medication dosing system. Weighted pediatric readiness scores improved in the majority of KPNC EDs between 2012 and 2015. The attention brought to pediatric readiness by the 2012 assessment, administrative buy-in, a pediatric champion in the ED, and collaboration with inpatient pediatrics were identified by emergency physician leaders as keys to improvement.

186 Pediatric Emergency Care Coordinators in US Emergency Departments

186 Pediatric Emergency Care Coordinators in US Emergency Departments

Resource Document: Coordination of Pediatric Emergency Care in EMS Systems

Background: Citing numerous pediatric-specific deficiencies within Emergency Medical Services (EMS) systems, the Institute of Medicine (IOM) recommended that EMS systems appoint a pediatric emergency care coordinator (PECC) to provide oversight of EMS activities related to care of children, to promote the integration of pediatric elements into day-to-day services as well as local and/or regional disaster planning, and to promote pediatric education across all levels of EMS providers. Methods: A systematic review of the literature was undertaken to describe the evidence for pediatric coordination across the emergency care continuum. The search strategy was developed by the investigators in consultation with a medical librarian and conducted in OVID, Medline, PubMed, Embase, Web of Science, and CINAHL databases from January 1, 1983 to January 1, 2016. All research articles that measured a patient-related or system-related outcome associated with pediatric coordination in the setting of emergency care, trauma, or disaster were included. Opinion articles, commentaries, and letters to the editors were excluded. Three investigators independently screened citations in a hierarchical manner and abstracted data. Results: Of 149 identified titles, nine were included in the systematic review. The nine articles included one interventional study, five surveys, and three consensus documents. All articles favored the presence of pediatric coordination. The interventional study demonstrated improved documentation, clinical management, and staff awareness of high priority pediatric areas. Conclusion: The current literature supports the identification of pediatric coordination to facilitate the optimal care of children within EMS systems. In order for EMS systems to provide high quality care to children, pediatric components must be integrated into all aspects of care including day-to-day operations, policies, protocols, available equipment and medications, quality improvement efforts, and disaster planning. This systematic review and resource document serves as the basis for the National Association of EMS Physicians position statement entitled “Physician Oversight of Pediatric Care in Emergency Medical Systems.”

Pediatric Readiness in Indian Health Service and Tribal Emergency Departments: Results from the National Pediatric Readiness Project

IntroductionIn 2014, 45 Indian Health Service (IHS)/Tribal emergency departments serving American Indian and Alaskan Native communities treated approximately 650,000 patients of which, 185,000 (28%) were children and youth younger than 19 years. This study presents the results of the National Pediatric Readiness Project (NPRP) assessment of the 45 IHS/Tribal emergency departments. MethodsData were obtained from the 2013 NPRP national assessment, which is a 55-question Web-based questionnaire based on previously published 2009 national consensus guidelines. The main measure of readiness is the weighted pediatric readiness score (WPRS), with the highest score being 100. ResultsThe overall mean WPRS for all emergency departments is 60.9. Of the IHS/Tribal emergency departments that had pediatric emergency care coordinators, scores across all domains were higher than those of emergency departments without pediatric emergency care coordinators. All 45 emergency departments have readily available a pediatric medication dosing chart, length-based tape, medical software, or other system to ensure proper sizing of resuscitation equipment and proper dosing of medication. Of the 45 IHS/Tribal 37% report having 100% of the equipment items, and 78% report having at least 80% of these items. DiscussionThis article reports the results of the NPRP assessment in IHS/Tribal emergency departments that, despite serving a historically vulnerable population, scored favorably when compared with national data. The survey identified areas for improvement, including implementation of QI processes, stocking of pediatric specific equipment, implementation of policies and procedures on interfacility transport, and maintaining staff pediatric competencies.

Pediatric Readiness and Facility Verification

We perform a needs assessment of pediatric readiness, using a novel scoring system in California emergency departments (EDs), and determine the effect of pediatric verification processes on pediatric readiness. ED nurse managers from all 335 acute care hospital EDs in California were sent a 60-question Web-based assessment. A weighted pediatric readiness score (WPRS), using a 100-point scale, and gap analysis were calculated for each participating ED. Nurse managers from 90% (300/335) of EDs completed the Web-based assessment, including 51 pediatric verified EDs, 67 designated trauma centers, and 31 EDs assessed for pediatric capabilities. Most pediatric visits (87%) occurred in nonchildren's hospitals. The overall median WPRS was 69 (interquartile ratio [IQR] 57.7, 85.9). Pediatric verified EDs had a higher WPRS (89.6; IQR 84.1, 94.1) compared with nonverified EDs (65.5; IQR 55.5, 76.3) and EDs assessed for pediatric capabilities (70.7; IQR 57.4, 88.9). When verification status and ED volume were controlled for, trauma center designation was not predictive of an increase in the WPRS. Forty-three percent of EDs reported the presence of a quality improvement plan that included pediatric elements, and 53% reported a pediatric emergency care coordinator. When coordinator and quality improvement plan were controlled for, the presence of at least 1 pediatric emergency care coordinator was associated with a higher WPRS (85; IQR 75, 93.1) versus EDs without a coordinator (58; IQR 50.1, 66.9), and the presence of a quality improvement plan was associated with a higher WPRS (88; IQR 76.7, 95) compared with that of hospitals without a plan (62; IQR 51.2, 68.7). Of pediatric verified EDs, 92% had a quality improvement plan for pediatric emergency care and 96% had a pediatric emergency care coordinator. We report on the first comprehensive statewide assessment of "pediatric readiness" in EDs according to the 2009 "Guidelines for Care of Children in the Emergency Department." The presence of a pediatric readiness verification process, pediatric emergency care coordinator, and quality improvement plan for pediatric emergency care was associated with higher levels of pediatric readiness.

A national assessment of pediatric readiness of emergency departments.

Previous assessments of readiness of emergency departments (EDs) have not been comprehensive and have shown relatively poor pediatric readiness, with a reported weighted pediatric readiness score (WPRS) of 55. To assess US EDs for pediatric readiness based on compliance with the 2009 guidelines for care of children in EDs; to evaluate the effect of physician/nurse pediatric emergency care coordinators (PECCs) on pediatric readiness; and to identify gaps for future quality initiatives by a national coalition. Web-based assessment of US EDs (excluding specialty hospitals and hospitals without an ED open 24 hours per day, 7 days per week) for pediatric readiness. All 5017 ED nurse managers were sent a 55-question web-based assessment. Assessments were administered from January 1 through August 23, 2013. Data were analyzed from September 12, 2013, through January 11, 2015. A modified Delphi process generated a WPRS. An adjusted WPRS was calculated excluding the points received for the presence of physician and nurse PECCs. Of the 5017 EDs contacted, 4149 (82.7%) responded, representing 24 million annual pediatric ED visits. Among the EDs entered in the analysis, 69.4% had low or medium pediatric volume and treated less than 14 children per day. The median WPRS was 68.9 (interquartile range [IQR] 56.1-83.6). The median WPRS increased by pediatric patient volume, from 61.4 (IQR, 49.5-73.6) for low-pediatric-volume EDs compared with 89.8 (IQR, 74.7-97.2) for high-pediatric-volume EDs (P < .001). The median percentage of recommended pediatric equipment available was 91% (IQR, 81%-98%). The presence of physician and nurse PECCs was associated with a higher adjusted median WPRS (82.2 [IQR, 69.7-92.5]) compared with no PECC (66.5 [IQR, 56.0-76.9]) across all pediatric volume categories (P < .001). The presence of PECCs increased the likelihood of having all the recommended components, including a pediatric quality improvement process (adjusted relative risk, 4.11 [95% CI, 3.37-5.02]). Barriers to guideline implementation were reported by 80.8% of responding EDs. These data demonstrate improvement in pediatric readiness of EDs compared with previous reports. The physician and nurse PECCs play an important role in pediatric readiness of EDs, and their presence is associated with improved compliance with published guidelines. Barriers to implementation of guidelines may be targeted for future initiatives by a national coalition whose goal is to ensure day-to-day pediatric readiness of our nation's EDs.

National survey of pediatric services available in US emergency departments

BackgroundChildren account for nearly 20% of all US emergency department (ED) visits, yet previous national surveys found that many EDs lack specialized pediatric care. In response, a 2001 joint policy statement recommended resources needed by EDs for effective pediatric emergency care delivery. We sought to update and enhance previous estimates of pediatric services available in US EDs.MethodsWe administered a telephone survey to a 5% random sample (n = 279) of all US EDs from the 2007 National Emergency Department Inventory-USA. The survey collected data on local capabilities (including typical management of three clinical scenarios) and prevalence of a coordinator for pediatric emergency care. We used descriptive statistics to summarize data. Multivariable logistic regression was used to examine the association between survey respondent and ED characteristics as well as the presence of a coordinator for pediatric emergency medicine.ResultsData were collected from 238 hospitals (85% response rate). A minority of hospitals had pediatric departments (36%) or intensive care units (12%). The median annual number of ED visits by children was 3,870 (interquartile range 1,500–8,800). Ten percent of hospitals had a separate pediatric ED; only 17% had a designated pediatric emergency care coordinator. Significant positive predictors of a coordinator were an ED pediatric visit volume of ≥1 patient per hour and urban location. Most EDs treated only mild-to-moderate cases of childhood bronchiolitis and asthma exacerbation (77% and 65%, respectively). Less than half (48%) of the hospitals reported the ability to surgically manage a child with acute appendicitis.ConclusionWe found little change in pediatric emergency services compared to earlier estimates. Our study results suggest a continued need for improvements to ensure access to emergency care for children.