THE CHALLENGE

Children have unique anatomic, physiologic, developmental, and medical needs that differ from adults. These differences put them at greater risk for variability in the quality and safety of the emergency care they receive. In 2006, the Institute of Medicine, in its Future of Emergency Care series,1 noted ongoing deficiencies in both the prehospital and emergency department (ED) settings, such as the availability of pediatric equipment, access to supplies and medications, training for medical staff, and policies incorporating the unique needs of children. While there have been marked improvements in many areas of everyday pediatric readiness, persistent variability among EDs and the need for improvement across the continuum of care remain.2-5

EMERGENCY DEPARTMENTS AND PEDIATRIC READINESS

The National Pediatric Readiness Project is a partnership between the federal Emergency Medical Services for Children Program, the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association.6 In phase one of the project, hospital ED leaders in all states and territories of the United States were asked to complete a comprehensive Web-based assessment of their readiness to provide care to children in EDs. The assessment was based on the policy statement, Guidelines for Care of Children in the Emergency Department,7 developed jointly by the American Academy of Pediatrics Committee on Pediatric Emergency Medicine, the American College of Emergency Physicians Pediatric Committee, and the Emergency Nurses Association Pediatric Committee. The response rate was a remarkable 83%, representing a sample of more than 4,000 EDs in the United States.4

• Most children are cared for in local smaller community hospitals. Many of these smaller facilities treat less than 15 children per day.
• About half of EDs reported having a physician (47.5%) or nurse (59.3%) pediatric emergency care coordinator. Even fewer EDs (45.1%) reported having a quality improvement (QI) plan that specifically addresses pediatric care. Of those EDs that have a QI plan, only 58.3% identified quality indicators particularly for children. Importantly, the presence of these pediatric quality indicators was independently associated with improved overall readiness scores.8
• About half of hospitals (46.8%) lacked important policies, procedures, or protocols, (including disaster policies) that address specific care needs for children.
• A process to ensure that weights are measured and recorded in kilograms only, an important safety concern in pediatric medicine, was also missing in more than a third of EDs that completed the assessment.

The data from the National Pediatric Readiness Project gave a snapshot of the nation’s capacity to provide care to children in EDs, information on needs at the state and national levels, and an indication of what could be done to improve readiness. For example:

While there is still little evidence to demonstrate that improved readiness results in improved emergency care, one study demonstrated that teams of healthcare providers who practiced in EDs with higher pediatric readiness scores performed better in a standardized simulation of the care required by children with sepsis.9

THE SOLUTION – THE FACILITY RECOGNITION COLLABORATIVE (FRC)

The EMSC Innovation and Improvement Center is spearheading a QI collaborative to assist state programs in accelerating their progress in improving the pediatric readiness of EDs and to develop a program to recognize EDs in their state that are ready to care for children with medical emergencies. State improvement teams will benefit by interacting with experts in both pediatric readiness and facility recognition, as well as a cadre of QI specialists.

MISSION STATEMENT

All children deserve timely access to EDs that are ready to provide immediate and appropriate care based on national guidelines for the care of children in EDs.

AIM STATEMENT

By December 2017, increase by 50% the number of states that have developed an implementation plan to recognize EDs that are ready to stabilize and/or manage children with medical emergencies based on national guidelines for the care of children in EDs.