Emergency Departments Report Greater Readiness to Handle Pediatric Cases

Emergency departments (EDs) in the United States are better prepared to handle pediatric cases based on their own self-reports, according to an article published today by JAMA Pediatrics.

The ability of EDs to care for children is key a number of patient safety and disaster planning efforts. In 2011, several organizations involved in emergency and pediatric care created a coalition to press for improvements in this area, and created a 55-question survey to gauge readiness, based on 2009 national guidelines.

Groups involved in this effort include the Emergency Nurses Association, the American Academy of Pediatrics, the American College of Emergency Physicians, and the federal Emergency Medical Services for Children (EMSC) program of the Health Resources and Services Administration.

Marianne Gausche-Hill, MD, of Harbor-University of California, Los Angeles, Medical Center, and coauthors report on ED readiness based responses from 4,137 EDs, which were included in the analysis and represent about 24 million annual pediatric ED visits. Results indicate a median weighted pediatric readiness score (WPRS) of 68.9, an improvement and increase from a previously reported WPRS score of 55.

Scores varied by pediatric patient volume with low-volume EDs having a median WPRS of 61.4; medium-volume EDS, 69.3; medium-to-high volume EDs, 74.8; and high-volume EDS, 89.8.

Of the EDs that responded, 1,966 (47.5%) reported having a physician pediatric emergency care coordinator; 2,455 EDs (59.3%) reported having a nurse coordinator and in 1,737 EDs (42%) there were 1 of each.

The results also show that lower-volume hospitals reported a higher percentage of family medicine-trained physicians caring for children (78.9 percent) compared with high-volume hospitals (32.1 percent), where most physicians caring for children were trained in emergency medicine or pediatric emergency medicine.

Nearly all the EDs (99.5%) reported staff were trained on the location of pediatric equipment in the ED, but only 45.1% of the EDS reported having a quality improvement plan addressing the needs of children. Only 46.8% of EDs reported having a disaster plan that addresses children.

Cost of training was a barrier to implementing readiness guidelines for more than half (54.5%), while a lack of educational resources was cited by 49%.

“These data demonstrate improvement in pediatric readiness of EDs compared with previous reports. (Care coordinators) play an important role in ensuring pediatric readiness of EDs and barriers may be targeted for future initiatives. We describe the successful implementation of a comprehensive assessment by a national coalition that achieved a high response rate and is poised for further engagement with the goal to ensure day-to-day pediatric readiness of our nation’s EDs,” the study concludes.

In a related editorial, Evaline A. Alessandrini, MD, MSCE, of Cincinnati Children’s Hospital Medical Center, and Joseph L. Wright, MD, MPH, of the Howard University College of Medicine, Washington, write of the importance of transparency in reporting readiness to care for children in the event of a disaster. While progress has been made, “There is still a long way to go,” they write.