Pediatric Readiness: In Press

  • Published September 18, 2019

August’s issue of Pediatrics, contains both a commentary by the EIIC’s Dr. Kate Remick and a retrospective cohort study examining the relationship between focusing on hospital-specific pediatric readiness and encounter mortality emergency care for children. The research found that children who presented to an ED with lower pediatric readiness scores had an increased risk-adjusted mortality with critical illness. Continued efforts to improve ED pediatric readiness may reduce mortality for children.

Remick KE. The Time Is Now: Uncovering the Value of Pediatric Readiness in Emergency Departments. Pediatrics. 2019;144(3):e20191636

"More than 80% of families depend on community, rural, and remote emergency departments (EDs) to care for their children who are sick and injured.1 In the great majority of cases, similar to in adult cases, a child’s straightforward illness or injury is easily managed, and the child is discharged from the hospital to his or her family.2 However, unlike adults, when a child presents with a critical illness or injury, most EDs are unprepared to quickly stabilize that child. In this issue of Pediatrics, Ames et al3 evaluate the potential impact of this gap in the study “Emergency Department Pediatric Readiness and Mortality in Critically Ill Children.” On the basis of a national self-assessment of pediatric readiness, EDs commonly lack ≥1 critical elements, including pediatric patient safety and clinical care policies, quality improvement (QI) processes to monitor pediatric emergency care delivery, oversight to ensure that pediatric needs are met and integrated into all aspects of emergency care, and maintenance of pediatric competencies.1,4–6

The National Pediatric Readiness Project, a national QI collaborative formed …"

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Ames SG, Davis BS, Marin JR, et al. Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics. 2019;144(3):e20190568

"BACKGROUND: Emergency departments (EDs) vary in their level of readiness to care for pediatric emergencies. We evaluated the effect of ED pediatric readiness on the mortality of critically ill children.

METHODS: We conducted a retrospective cohort study in Florida, Iowa, Massachusetts, Nebraska, and New York, focusing on patients aged 0 to 18 years with critical illness, defined as requiring intensive care admission or experiencing death during the encounter. We used ED and inpatient administrative data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project linked to hospital-specific data from the 2013 National Pediatric Readiness Project. The relationship between hospital-specific pediatric readiness and encounter mortality in the entire cohort and in condition-specific subgroups was evaluated by using multivariable logistic regression and fractional polynomials.

RESULTS: We studied 20 483 critically ill children presenting to 426 hospitals. The median weighted pediatric readiness score was 74.8 (interquartile range: 59.3–88.0; range: 29.6–100). Unadjusted in-hospital mortality decreased with increasing readiness score (mortality by lowest to highest readiness quartile: 11.1%, 5.4%, 4.9%, and 3.4%; P < .001 for trend). Adjusting for age, chronic complex conditions, and severity of illness, presentation to a hospital in the highest readiness quartile was associated with decreased odds of in-hospital mortality (adjusted odds ratio compared with the lowest quartile: 0.25; 95% confidence interval: 0.18–0.37; P < .001). Similar results were seen in specific subgroups.

CONCLUSIONS: Presentation to hospitals with a high pediatric readiness score is associated with decreased mortality. Efforts to increase ED readiness for pediatric emergencies may improve patient outcomes."

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