Pediatric readiness has improved in emergency departments across the country, as measured by EDs’ compliance with 2009 guidelines for emergency care in children, according to a report published online April 13 in JAMA Pediatrics.
In what they described as “the most comprehensive evaluation of pediatric readiness of our nation’s EDs to date,” investigators performed a web-based assessment of 4,137 hospitals’ self-reported compliance with guidelines addressing child-specific emergency care. The overall median weighted pediatric readiness score (WPRS) was 68.9, a solid improvement over the previously reported median WPRS of 55, said Dr. Marianne Gausche-Hill of Harbor-UCLA Medical Center, Torrance, Calif., and her associates.
Dr. Marianne Gausche-Hill
The single most important factor found to enhance pediatric readiness was to designate two people, one of whom is a physician or nurse, as the hospital’s pediatric emergency care coordinator, as recommended by the Institute of Medicine, the researchers wrote. Nearly half (47.5%) of EDs now have a physician coordinator, and 59.3% now have a nurse coordinator, compared with 18% and 12%, respectively, in a previous report. The presence of coordinators quadrupled the chances that a hospital would put important quality-improvement plans in place to address children’s care needs, the investigators said (JAMA Pediatr. 2015 April 13 [doi:10.1001/jamapediatrics.2015.138]).
Other findings included the following:
• Most physicians providing emergency care for children were specifically trained in emergency medicine (88.6%) or pediatric emergency medicine (55.4%) at high-volume hospitals; low-volume hospitals were more likely to have family-medicine-trained physicians doing so (78.9%).
• Mandatory competency evaluations for providing pediatric emergency care were relatively common for nurses (66.6%) but less so for physicians (38.7%) and midlevel staff (18.1%).
• 99.5% of EDs said all staff are trained on the location of pediatric equipment in the ED, including tools to ensure correct sizing of resuscitation equipment and appropriate dosing of medications.
• 83.1% of EDs said they verified the proper location and function of pediatric equipment daily.
• EDs routinely stocked 91% of recommended pediatric equipment. Equipment that was missing in more than 15% of EDs included laryngeal mask airways, umbilical vein catheters, central venous catheters, tracheostomy tubes, size 00 laryngoscope blades, continuous end-tidal carbon dioxide monitoring equipment, pediatric Magill forceps, and infant and child nasopharyngeal airways.
• Only 46.8% of EDs had disaster plans that specifically addressed children, as recommended. Even among high-volume hospitals, which were the most compliant with guidelines, only 67.4% had such disaster plans.
• Approximately one-third of EDs said their providers failed to weigh children and record the weight in kilograms only, as recommended. This safety measure is crucial to preventing drug-dosing errors.
• The most frequently cited barriers to complying with guidelines were the cost of child-specific training (reported by 54.4% of EDs) and a lack of educational resources (reported by 49.0%). Few EDs reported that a lack of interest was a barrier to implementing the guidelines.
This project was supported by the Emergency Medical Services for Children network and the EMS for Children National Resource Center under the U.S. Department of Health & Human Services. Dr. Gausche-Hill and her associates reported having no financial disclosures.