Pediatric Readiness and Facility Verification - 23/02/16

Doi : 10.1016/j.annemergmed.2015.07.500

Katherine Remick, MD ^a,^⁎ , Amy H. Kaji, MD, PhD ^b,^d,^e, Lenora Olson, PhD, MA ^f, Michael Ely, MHRM ^f, Patricia Schmuhl, BA ^f, Nancy McGrath, RN, MN ^b,^d,^g, Elizabeth Edgerton, MD, MPH ^h, Marianne Gausche-Hill, MD ^b,^c,^d,^e
^a Austin–Travis County EMS System, Office of the Medical Director, and the Dell Children’s Medical Center, Austin, TX
^b Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
^c Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA
^d Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA
^e David Geffen School of Medicine at UCLA, Los Angeles, CA
^f University of Utah Department of Pediatrics, National EMSC Data Analysis Resource Center, Salt Lake City, UT
^g UCLA School of Nursing, Los Angeles, CA
^h EMSC and Injury Prevention, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD

^∗Corresponding Author.

Abstract

Study objective

We perform a needs assessment of pediatric readiness, using a novel scoring system in California emergency departments (EDs), and determine the effect of pediatric verification processes on pediatric readiness.

Methods

ED nurse managers from all 335 acute care hospital EDs in California were sent a 60-question Web-based assessment. A weighted pediatric readiness score (WPRS), using a 100-point scale, and gap analysis were calculated for each participating ED.

Results

Nurse managers from 90% (300/335) of EDs completed the Web-based assessment, including 51 pediatric verified EDs, 67 designated trauma centers, and 31 EDs assessed for pediatric capabilities. Most pediatric visits (87%) occurred in nonchildren’s hospitals. The overall median WPRS was 69 (interquartile ratio [IQR] 57.7, 85.9). Pediatric verified EDs had a higher WPRS (89.6; IQR 84.1, 94.1) compared with nonverified EDs (65.5; IQR 55.5, 76.3) and EDs assessed for pediatric capabilities (70.7; IQR 57.4, 88.9). When verification status and ED volume were controlled for, trauma center designation was not predictive of an increase in the WPRS. Forty-three percent of EDs reported the presence of a quality improvement plan that included pediatric elements, and 53% reported a pediatric emergency care coordinator. When coordinator and quality improvement plan were controlled for, the presence of at least 1 pediatric emergency care coordinator was associated with a higher WPRS (85; IQR 75, 93.1) versus EDs without a coordinator (58; IQR 50.1, 66.9), and the presence of a quality improvement plan was associated with a higher WPRS (88; IQR 76.7, 95) compared with that of hospitals without a plan (62; IQR 51.2, 68.7). Of pediatric verified EDs, 92% had a quality improvement plan for pediatric emergency care and 96% had a pediatric emergency care coordinator.

Conclusion

We report on the first comprehensive statewide assessment of “pediatric readiness” in EDs according to the 2009 “Guidelines for Care of Children in the Emergency Department.” The presence of a pediatric readiness verification process, pediatric emergency care coordinator, and quality improvement plan for pediatric emergency care was associated with higher levels of pediatric readiness.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design and Setting

Selection of Participants

Methods of Measurement

Outcome Measures

Primary Data Analysis

Results

Limitations

Discussion

	Please see page 321 for the Editor’s Capsule Summary of this article.
	Supervising editors: Lise E. Nigrovic, MD, MPH; Steven M. Green, MD
	Author contributions: KR, LO, ME, EE, and MG-H conceived the study, designed the assessment, and obtained funding. KR, NM, and MG-H recruited participants and designed outreach campaign. LO, ME, and PS supervised the assessment deployment and data collection. AHK conducted statistical analysis and interpretation. KR and AHK drafted the article, and all other authors contributed substantially to its revision. KR takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: This study was supported in part by California Emergency Medical Services Authority state partnership grant 1084-1 A1. This project was also partially supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant U03MC00008, Emergency Medical Service for Children Network Development (20% financed with nongovernmental sources).
	This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the US government.
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