About the PRQC

In 2013, the Emergency Medical Services for Children (EMSC) Program in partnership with the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association launched the National Pediatric Readiness Project (NPRP) to ensure high quality emergency care for children regardless of their geographic location.  The project began with a national assessment based on the 2009 “Guidelines for Care of Children in the Emergency Department,” to determine the capacity of our nation’s emergency departments to meet the needs of children.  The 2013 National Pediatric Readiness Assessment had a remarkable 83% of EDs across the US participate.   This was a clear indication of the nation’s desire to ensure high quality emergency care for children.   Common gaps identified included:

  •       Presence of physician (47.5%) and nurse (59.3%) pediatric emergency care coordinators (PECC);
  •       Presence of quality improvement plans that include children (45.1%); 
  •       Process to ensure pediatric weights are measured in kilograms (67.7%);
  •       Presence of inter-facility transfer guidelines (70.6%);
  •      Presence of disaster plans that include pediatric-specific needs (46.8%).[1]

Equally important was the finding that the majority of children who seek emergency care (69.4%) are cared for in emergency departments that see fewer than 15 pediatric patients per day – local, community emergency departments. Even among low volume pediatric facilities, the presence of a PECC/pediatric champion was strongly correlated with improved pediatric readiness, independent of other factors.  In addition, the presence of a QI plan that included pediatric-specific indicators was found to be independently associated with improved overall readiness.[2]

These findings are particularly important in light of the common barriers reported by participants in the NPRP assessment:

  •         Cost of training personnel;[3]
  •         Lack of educational resources;
  •         Lack of a QI plan for children. 

Quality improvement science has been proven to be a timely and effective approach to integrating best practices and recent evidence based guidelines into healthcare. Quality improvement collaboratives further this by allowing teams to learn from one another, test changes to improve quality, and use their collective experience and data to understand, implement, and disseminate best practices for common adoption.  The Health Resources and Services Administration in collaboration with the EMS for Children Innovation and Improvement Center (EIIC) sponsors national quality improvement collaboratives that align with the Institute for Healthcare Improvement’s Breakthrough Series collaborative model to facilitate rapid adoption of evidence-based guidelines that result in short-term transformation of healthcare for patients.[4],[5] 

Based on the findings described above, the EIIC will launch the First National Pediatric Readiness Quality Collaborative to support efforts in states and territories at the local level to meet the emergency care needs of children. 

REFERENCES

  1. Gausche-Hill M, Ely M, Schmuhl P, Telford R, Remick KE, Edgerton EA, Olson LM. A National Assessment of Pediatric Readiness of Emergency Departments. JAMA Pediatr. 2015;169(6):527-534. doi:10.1001/jamapediatrics.2015.138
  2. Remick, K., Kaji, A.H., Olson, L. et al, Pediatric readiness and facility verification. Ann Emerg Med. 2016;67:320–328. doi: 10.1016/j.annemergmed.2015.07.500. 
  3. Lannon CM, Peterson LE. Pediatric collaborative improvement networks: background and overview. Pediatrics. 2013;131(suppl 4):S189–S195. doi: 10.1542/peds.2012-3786E.
  4. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)