428 - Measuring Pediatric Readiness in a Large Healthcare System

Publication Number: 428.5821

Stacy L. Reynolds, Atrium Health Levine Children's Hospital, Charlotte, NC, United States; Monica Watts, Levine Children's Hospital, Matthews, NC, United States; Ivelisse Sanchez, Advocate Children's Hospital - Park Ridge, Park Ridge, IL, United States; Michele L. Daniels, Atrium Health Wake Forest Baptist Health, Winston Salem, NC, United States; Lillie S. Montgomery, Levine Children's Hospital, Byron, GA, United States; jacob Kirkpatrick, Mercer University School of Medicine, Warner Robins, GA, United States; Shannon E. Staley, Advocate Children's Hospital - Oak Lawn, Lemont, IL, United States; Michael S. Mitchell, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: The National Pediatric Readiness Project Assessment (NPRPS) score is associated with decreased mortality among acutely ill and injured children. (JAMA 2023) This validated tool provides an important measure of pediatric readiness in health system-based emergency networks.

Objective: Measure pediatric readiness in a large healthcare system at the site, market, state and regional levels to capture improvement priorities.

Design/Methods: A healthcare system comprised of five children’s hospital emergency departments (EDs) and 53 community EDs across five states scored readiness in current operations using the NPRP Assessment (2021) via REDCap (version 14.0.43) from February to May 2024. Regulatory requirements for pediatric readiness (including requirements for pediatric emergency care coordinators [PECCs] and quality improvement (QI) programs) existed in one state impacting 2 children’s hospital and 7 community EDs. Data were aggregated by hospital, market, state, and region to align improvement prioritization with healthcare system and Emergency Medical Services for Children (EMSC) structures. Readiness scores were analyzed to categorize EDs using performance tiers from a prior study on the association of ED pediatric readiness and mortality as follows: top quartile (88–100), third quartile (73–87), second quartile (59–72), and first quartile (0–58). (JAMA 2023) The team analyzed the volume of pediatric patients served by site and quartile and assessed performance domains. The institutional review board reviewed the project.

Results: Fifty-five of 58 EDs participated. A total of 411,340 pediatric emergency care visits occurred during the study period. Median readiness for the system was 72 (range 26–100). Top quartile EDs served 42% of children; third quartile EDs served 28%; second quartile EDs served 17%; and first quartile EDs served 13%. Median score for the nine EDs with state requirements for pediatric care was 94 (range 52–100). In this state, 80% of children received care in a top quartile ED. Fifty-one percent of EDs reported seeing less than 5,000 children per year. PECC physician and nursing dyads existed in only 31% of EDs. Only 49% of EDs reported a QI program for children and less than 40% used quality indicators and outcome-based measures.

Conclusion(s): Implementing a pediatric readiness assessment in a large healthcare system identified important gaps including the number of children served in EDs with low readiness. Legislative standards requiring the addition of PECCs and QI work elevated the number of children served in top quartile EDs.

Children Served in 55 Emergency Departments Based on Pediatric Performance Tier