What does it mean to be “Pediatric Ready”?

Currently, Pediatric Readiness is measured on a scale of 0-100 by the NPRP Assessment, which is based on national guidelines, “Pediatric Readiness in the Emergency Department,” developed by leading professional societies. This voluntary assessment is a single, though important, tool for measuring readiness. It represents a baseline of the essential elements needed to care for and stabilize a child in the ED. Recent studies have identified a score of 88 or above on the assessment as associated with improved outcomes. Research is ongoing, and every step toward achieving high Pediatric Readiness is important.

Is Pediatric Readiness in EDs improving?

Yes, in many areas. EDs have made significant progress in Pediatric Readiness, as outlined in a research paper about the results of the 2021 NPRP Assessment. 2021 scores improved from 2013 scores in five out of six assessment categories (among comparable questions). This is especially notable given the most recent assessment took place during the extraordinary challenges of the COVID-19 pandemic. A new national assessment in 2026 is based on updated guidelines and will further explore the nation’s readiness to provide high quality care for children in emergencies.

What are Pediatric Readiness recognition programs? Can an ED still be prepared for children if it is not recognized by one?

Nearly all states and territories have an Emergency Medical Services for Children (EMSC) Program working to improve Pediatric Readiness. States monitor and collaborate with EDs to help them address gaps and improve readiness through state-led initiatives, such as Pediatric Readiness recognition programs. These programs recognize and celebrate EDs for taking steps to become Pediatric Ready. They encourage improvements in care, enhance coordination, and help ensure children receive appropriate treatment from well-prepared facilities.

If an ED has not been included in a state Pediatric Readiness recognition program, it does not necessarily mean the ED is not Pediatric Ready. Participation in both the NPRP Assessment and most recognition programs is voluntary. The state may not yet have a recognition program or the ED may not have applied to participate yet.

Can I access my local ED’s score? Is ED data publicly available?

To an extent. To encourage participation and engagement in the project, individual ED scores are not publicly available. However, national-level results and data are publicly available. Researchers can request national-, state-, and hospital-level data for research purposes through a verified application process that requires strict protocols for data confidentiality.

Should I take my child to a pediatric-specific ED vs. a general one?

In the case of a health emergency, calling 911 or going to your nearby ED is typically the best choice. 90% of children receive care in general and community EDs. All accredited EDs must meet certain standards of care, and most children visit the ED for mild or moderate illness or injury.

Pediatric Readiness is about taking steps to continually provide the best possible care for all children in all cases, including severe and/or uncommon illnesses or injuries, and including transfer to a hospital with more appropriate resources (such as a children's hospital) if needed.

Is it possible for all EDs to be prepared for pediatric emergency care?

Yes. Pediatric Readiness is attainable for all EDs. Research estimates the cost for EDs to achieve high Pediatric Readiness ranges from $4 to $48 per patient, which is low compared to many life-saving public health interventions.

What is the NPRP Nationwide Assessment?

The 2026 NPRP Nationwide Assessment is a free, voluntary, evidence-based assessment of EDs across the U.S. that will take place March - May 2026. The assessment provides a national report card on Pediatric Readiness, determining progress, identifying gaps, and promoting quality improvement (QI) efforts in hospital EDs and around the country.

What are the benefits of participating?

The 2026 NPRP Nationwide Assessment is an opportunity to be part of the national "report card" on pediatric emergency care and is the first assessment that aligns with newly released joint guidelines. EDs that complete the assessment will immediately receive a gap report that includes:

1. Your ED’s Pediatric Readiness score from 0 – 100
2. Average scores of EDs of similar pediatric volume
3. Average score of all participating EDs to use as a benchmark
4. Analysis to target efforts for improvement in Pediatric Readiness

Most importantly, it benefits patients and families! EDs with higher Pediatric Readiness scores are associated with better outcomes compared to those with lower readiness scores: up to 76% lower mortality risk for children with critical illness and 60% lower mortality risk for children with critical injury. Thus, improving Pediatric Readiness improves outcomes for children and their families.

What national organizations support these efforts?

The project is supported by the leading professional societies representing emergency physicians, emergency nurses, pediatricians, and trauma surgeons as well as the Federal Emergency Medical Services for Children (EMSC) Program.

How is the assessment administered?

The assessment is administered by the Emergency Medical Services for Children (EMSC) Program's Data Center through a secure web-based system. Assessment data are held within a secure server and results are only shared at each responding hospital with the person completing the assessment (who ideally then shares it with their ED and hospital leadership) and are also shared with the state’s EMSC State Partnership grantee.

What is the assessment measuring?

The National Pediatric Readiness Project Assessment provides a basic indicator of an ED’s capacity to treat pediatric patients. It includes questions that address the following areas as outlined by the “Pediatric Readiness in the Emergency Department: Policy Statement.”

• Administration and Coordination;
• Competencies for Physicians, Nurses, and Other ED Staff;
• QI/PI in the Emergency Department (ED);
• Pediatric Patient and Medication Safety;
• Policies, Procedures, and Protocols;
• Support Services; and
• Equipment, Supplies, and Medications

Are individual hospital scores public?

No. All individual ED scores are confidential. Only aggregate, national- or state-level data are publicly reported.

Who should complete the assessment?

Any facility with a 24/7 ED is encouraged to complete the assessment. This includes freestanding EDs that are open 24/7. Prison hospitals are excluded. Typically the ED nurse manager at each facility receives an invitation to complete the assessment on behalf of their ED. Since only one assessment per ED can be submitted, we encourage ED nurse managers to print a PDF copy of the NPRP Assessment to review and coordinate with their ED medical director and nurse leadership before taking it online.

My facility is an urgent care center with a 24/7 ED. Can we take the assessment?

Yes. If your facility is licensed as an ED and operates 24/7, you can take the NPRP Assessment. If your facility is licensed as an urgent care center, you cannot take the NPRP Assessment.

Are freestanding EDs included?

Yes. Freestanding EDs that operate 24/7 are strongly encouraged to participate.

My ED is closed on major holidays. Do we qualify as a 24/7 ED?

An ED must be open 24/7 to qualify to take the assessment.

My ED is part of a larger hospital system. Should I answer on behalf of the system or my individual ED site?

The assessment seeks to understand care at the site level. Please answer questions only on behalf of your individual ED. In the assessment, the term “hospital” is used to indicate the hospital or facility where your ED is located.

How can I prepare for the assessment?

For more information about the NPRP Nationwide Assessment, visit PedsReady.org. You can download and print a PDF copy before submitting your responses. You can also view the NPRP's ED Checklist and ED Toolkit.

How does my ED participate in the NPRP Assessment?

The nationwide assessment will take place March - May 2026. An identified contact person at each ED, often the ED nurse manager, will receive email notifications with a link inviting their ED to take the web-based assessment.

Since only one assessment per ED can be completed during the national period, we encourage you to print and review a PDF of the assessment before taking it online at PedsReady.org (or review the ED Checklist). It is important to collaborate with ED leadership prior to submitting the assessment to ensure all are aware and have reviewed responses.

Do we need to upload policies or proof to verify our responses?

No. The assessment is honor-based. Organizations that verify, accredit, or recognize EDs for readiness activities (i.e. American College of Surgeons trauma center verification, American College of Emergency Physicians ED accreditation, or state Pediatric Readiness Recognition Programs) may ask to verify your participation or specific responses. Please contact the organization to learn more about their requirements.

How long is the NPRP Nationwide Assessment open?

The 2026 Nationwide Assessment runs from March - May 2026. We strongly encourage participation from all 24/7 EDs. Once the national period is over, the PedsReady.org website will maintain an “open assessment” period for EDs to take the assessment as many times as they like for internal quality and performance improvement purposes. These responses will not be included as part of the national aggregate report card.

What if I start taking the assessment and have to come back to it later?

If you cannot finish the assessment in one sitting, you will be able to resume your progress from any page by clicking on the “Save and Exit” button. This will take you to a page where you must supply your email address to receive an email with a link to your assessment. When you are ready to resume the assessment, from the same computer, click on the web address from the email message and you will be directed to the page of the assessment where you exited.

What types of questions are asked on the 2026 NPRP Nationwide Assessment?

The NPRP Assessment asks questions based on the 2026 guidelines for the care of children in the ED including: infrastructure, resources, personnel, the administration and coordination of care for children, policies, equipment, and more. We strongly encourage ED nurse managers to download and print a PDF copy of the NPRP Assessment and review before submitting their responses online at PedsReady.org.

My ED participated in the last assessment. What’s new on the 2026 assessment?

The 2026 NPRP Nationwide Assessment is based on recently updated national guidelines, “Pediatric Readiness in the Emergency Department,” developed by leading professional societies. The recommendations continue to emphasize many of the same key readiness elements, like the importance of appointing both nurse and physician pediatric emergency care coordinators (PECCs). A summary of updates can be found on this "What's New" flyer.

My ED made progress on Pediatric Readiness as defined by the last set of guidelines. We are concerned we won’t do as well given the 2026 recommendations are very new. What do you recommend?

The majority of key elements in the updated guidelines remain the same as in past guidelines. The 2026 changes often reflect increased focus on an existing area of readiness or more specific recommendations about an existing area of readiness.

In addition, keep in mind that questions are weighted. Major, well-established elements of Pediatric Readiness, like having a nurse and physician pediatric emergency care coordinators (PECCs), are weighted much more heavily than an individual piece of equipment, for example.

How does the assessment define children in terms of age?

For the purposes of the 2026 NPRP Assessment, the definition of a pediatric patient is based on how each facility defines a pediatric patient. For most facilities, it is defined as any person up to the age of 18 years old.

Questions on PECCs

If someone at my hospital is appointed to oversee all administrative aspects of Pediatric Readiness but does not hold the title of PECC, should I check "no" to the presence of a PECC?

No, the specific title is less important than the job description and responsibilities. Anyone appointed by leadership to oversee Pediatric Readiness improvement activities meets the criteria for presence of a PECC.

Does PECC time need to be protected?

Protected time is recommended but is not a required/scored item in the assessment.

Does the PECC need to be an RN or physician?

The assessment asks for RN and MD/DO PECCs. Advanced practice providers, paramedics and others may support the role, but RN/MD leadership is recommended.

Questions on Education and Competencies

Does PALS count for questions regarding staff pediatric education/certifications? Does it have to be CPEN?

In the 2026 assessment, there are a few questions around policies for nursing requirements for pediatric education and competencies.

1. If your ED requires nurses to complete any form of ongoing pediatric education or competency training, you may answer “yes” to the first (or gateway) question in this section.
2. If your nursing staff is required to maintain pediatric emergency continuing education or certification that addresses pediatric emergency nursing care, such as PALS, ENPC, or NRP, you can answer “yes” to the next question about pediatric continuing education.
3. If your ED requires nursing staff to maintain pediatric specialty certification for nurses, such as CPN, CPEN and/or CEN you can answer “yes" to the next question about specialty certification; if nurses are required to take PALS but do not have CPN, CPEN or CEN then the answer is “no".
4. If your hospital has competency evaluations requirements specific to your hospital, such as education on procedural sedation or triage for nursing staff that staff must complete at some recurrent basis, you can answer “yes" to the final question in this section about hospital-specific pediatric competency evaluations.

Are PALS or NRP required?

No. Ongoing pediatric education and competency are required, but specific courses (PALS, NRP) are not mandated by the guidelines (though they may be required by your organization).

Are specialty nursing certifications (e.g., CEN, CPEN) required at a certain percentage?

No specific percentage is required.

Is there a minimum number of hours for pediatric clinician competency?

No. Each ED defines its own requirement.

Policies, Protocols and Procedures

The new guidelines include a lot of specific pediatric clinical policies, protocols, or procedures. What resources exist to help our ED establish these?

The expectation is not for EDs to have electronic decision support tools or order sets for each clinical policy, or protocol, or procedure, but to have some standardized guidance in whatever form makes the most sense for that ED. EDs could choose a variety of formats (policy, protocol, clinical algorithm, etc.). It is also not the expectation that EDs develop these from scratch but rather that they adopt from other sources (e.g. a regional children's hospital/tertiary care center). Several resources exist but a good starting place is the NPRP Toolkit.

Perhaps, most importantly, the 2026 assessment does not require EDs to have a policy, protocol, or procedure for every single clinical condition within the checklist. Rather, the goal is that each ED has at least some (one or more) clinical pediatric protocols or clinical care algorithms for common conditions seen in their ED.

Does telemedicine include phone consultation?

Yes, the availability of phone consultation with pediatric subspecialty physicians counts as telemedicine.

Do pediatric policies need to be standalone?

No. Adult or trauma policies may include pediatric components as long as they are clearly defined.

Do protocols need to be hospital-specific?

No. Shared or partner hospital pediatric protocols are acceptable if readily accessible and current.

Our electronic medical record (EMR) weighs and records in both pounds and kilograms. Does this meet criteria for weighing and recording in kilograms?

No. If your EMR documents both pounds and kilograms, then this would not meet this metric. Children’s weights should be weighed and recorded in kilograms only. Consider checking with your IT department to adjust the EMR to be in kilograms only.

My ED is part of a larger system, and we typically transfer children within our system. Do we need to have interfacility transfer guidelines?

We still recommend interfacility transfer guidelines that specify criteria for which patients should be transferred and to where based on capabilities. They should also include other components of transfer, such as ensuring belongings go with the patient, that caregivers know how to get to the next facility, etc.

My ED asks about immunizations if it’s applicable but does not routinely ask that question of otherwise well children. Would that count as having a policy, procedure, or plan that includes immunization assessment and management of children?

For the 2026 assessment, you may answer “yes” if your ED has a policy, procedure, or plan that includes screening for urgent immunization needs based on a patient’s clinical presentation—for example, identifying when tetanus vaccination is needed for wounds, burns, or lacerations, or when a patient with fever is not up to date on immunizations and may be at higher risk for vaccine preventable diseases. Ideally, all children seen in the ED should have their immunization status reviewed.

Will the ED receive feedback on the assessment?

Yes. Each ED that completes the assessment receives immediate feedback in the form of a gap report. This report highlights a Pediatric Readiness Score on a scale of 0-100. It also outlines an EDs strengths and opportunities for quality improvement.

How do we receive the gap report?

The gap report will automatically open upon completion. Please save or print this report to a PDF. An access code will also be emailed to you if you need to re-access the report in the future.

Can we re-access the gap report later?

Yes. You will receive an email with a link and access code to reprint your report if needed.

Can we access prior assessments or gap reports?

When you complete the 2026 NPRP Nationwide Assessment, you will receive a gap report that shows a comparison to the previous time your ED took it. For information about prior assessments or gap reports, contact your state EMSC Program Manager.

What are “importance statements” shown on the gap report?

The purpose of importance statements shown in the gap report is to provide additional context to the importance of specific Pediatric Readiness domains within the NPRP Assessment as outlined by the 2026 Joint Policy Statement, “Pediatric Readiness in the Emergency Department."

When a Pediatric Readiness measure is not met on the NPRP Assessment, corresponding “importance statements” appear on a gap report to educate the respondent about the measure and highlight opportunities for quality improvement (QI) for their ED. If a Pediatric Readiness measure is met, an importance statement will not appear on the gap report.

We just took the NPRP Nationwide Assessment and want to learn more about how to improve Pediatric Readiness. What resources do you have available?

Thank you for participating! We appreciate your interest in learning more about Pediatric Readiness for your ED. Here are some great resources and places to start:

• Explore the NPRP Toolkit, a collection of resources, templates, and examples specifically designed for improving Pediatric Readiness.
• Enroll in the National Pediatric Readiness Quality Initiative, which offers a free data dashboard, reports, and more to help you track pediatric quality indicators.
• Join a monthly Pediatric Readiness webinar series on clinical topics.
• Connect with your EMSC State Partnership manager.

Review the full joint policy statement, “Pediatric Readiness in the Emergency Department.”

Where can we find suggested QI topics or measures?

NPRQI provides a free, secure, confidential platform and resources for pediatric QI work, including pediatric quality measures. These measures are highlighted in the 2026 guidelines updates.

Is there a target benchmark for QI measures?

No fixed targets yet; however, NPRQI offers 28 recommended measures and benchmarking against national cohorts that can help EDs to frame their current performance.