Three Leading Drivers of Improved Pediatric Readiness

Nurse taking assessment

This resource highlights the three factors most strongly associated with higher Pediatric Readiness scores in emergency departments (EDs), based on findings from the 2021 National Pediatric Readiness Project (NPRP) Nationwide Assessment. This guide is intended to help ED leaders identify practical, high-impact strategies to improve readiness for children, particularly when time, staffing, or resources are limited.


Why this matters

As outlined by the toolkit section “Appoint a PECC,” the presence of designated Pediatric Emergency Care Coordinators, a physician PECC and a nurse PECC, is the strongest and most consistent driver of higher Pediatric Readiness scores.


What this looks like in practice

  • A physician and nurse are formally identified for the role with support from leadership.

  • Responsibility for coordinating pediatric policies, education, equipment, and QI.

  • Ongoing oversight of Pediatric Readiness activities rather than one-time implementation.

Considerations and suggestions

  • PECCs do not need to be pediatric experts; having an interest in improving pediatric care is enough.

  • Clearly defining the role improves sustainability, especially with staff turnover.

  • Even limited protected time can meaningfully support progress.

  • Physician–nurse PECC dyads are more effective than single-role models

How EDs can prioritize this driver

  • Start by formally naming PECCs, even if roles are part-time.

  • Align PECC responsibilities with gaps identified in assessment results.

  • Integrate PECCs into existing committees or operational structures.

Why this matters

EDs with intentional pediatric-focused quality improvement (QI) activities and plans consistently demonstrate higher readiness. Readiness improves when pediatric care is addressed systematically, rather than focusing on individual aspects.


What this looks like in practice

  • A separate pediatric QI plan is not required. Pediatric measures can be embedded into existing QI structure.

  • Make improvements based on performance, or what’s not working well, and monitor results over time.

  • High-risk, low-frequency pediatric events are strong starting points.

Considerations and suggestions

  • Explore the National Pediatric Readiness Quality Initiative (NPRQI), a free pediatric QI data analysis and dashboard tool. EDs can choose from up to 28 trackable pediatric quality indicators.

How EDs can prioritize this driver

  • Use assessment data to identify priority conditions or processes.

  • Start with one or two pediatric-focused QI initiatives.

  • Ensure pediatric needs are explicitly included in broader ED QI efforts.

Why this matters

EDs staffed by physicians board-certified in emergency medicine (EM) or pediatric emergency medicine (PEM) have higher Pediatric Readiness scores. This staffing model supports consistent clinical expertise and strengthens adoption of pediatric protocols and best practices.


What this looks like in practice

  • Regular coverage by EM- or PEM-board certified physicians.

  • Clinical leadership that reinforces pediatric standards of care.

  • Collaboration with nursing and ancillary staff around pediatric workflows.

Considerations and suggestions

  • Board certification in EM or PEM is associated with higher readiness but does not replace systems-level supports.

  • Ongoing education remains important even when staffing with board-certified physicians.

How EDs can prioritize this driver

  • Assess current physician staffing patterns and certification mix.

  • Pair physician expertise with strong PECC leadership and policies.

  • Use staffing data to inform recruitment, onboarding, or training strategies.


EDs do not need to address every readiness element at once. Prioritizing improvement in one or more of these areas, guided by assessment results, can lead to meaningful, measurable gains in Pediatric Readiness and safer emergency care for children.