Where hospitals can improve in pediatric emergency care

Hospitals are making strides in improving pediatric emergency care, but a new study suggests areas for improvement, including designated coordinators of emergency care for children. (Image credit: ©Bethany - stock.adobe.com)

Hospitals are making strides in improving pediatric emergency care, but they still are falling short in some ways, according to a new study.

Specifically, more hospitals should be designating doctors and nurses, ideally both, to serve as pediatric emergency care coordinators, according to a 2021 analysis by the National Pediatric Readiness Project. The findings of the study were published July 7 in Jama Network Open.

The readiness project is a partnership of the Emergency Nurses Association, the American Academy of Pediatrics and the American College of Emergency Physicians. The U.S. Health Resources and Services Administration led the analysis, the first of its kind since a similar study was done in 2013.

• Read more: Children’s hospitals continue to face financial pressures

More than 3,500 emergency departments were analyzed, and using a 100-point scale, the median score was 69.5. Researchers say a score of 88 denotes improved odds of survival.

“The pediatric readiness score did not demonstrate significant overall improvement since 2013, however there remains a high level of engagement by frontline health care professionals in pediatric readiness efforts, as noted by improvements in all domains of readiness except administration and coordination,” the authors wrote.

On the upside, Kate Remick, the study’s lead author and co-director of the National Pediatric Readiness Project, said researchers found improvement in five of six areas.

“This is especially positive given EDs were navigating the pandemic at the time of the survey,” Remick said in a statement.

However, fewer hospitals have designated pediatric emergency care coordinators. While researchers concluded that change is likely driven by financial woes during the pandemic, they said it’s troubling because those coordinators can play a valuable role in ensuring the best care for children and teens in the emergency department.

Researchers found 28.5% of emergency departments said they had both physician and nurse pediatric emergency care coordinators, a 13.5% drop from 2013.

Pediatric emergency care coordinators “are a key driver of pediatric readiness,” Hilary Hewes, the study’s co-author, said in a statement. “Unfortunately, the pandemic worsened widespread workforce shortages. Many EDs didn’t have resources to sustain the PECC role.”

The study found more hospitals have stocked their emergency departments with the recommended equipment and supplies for children. Nearly three out of five (59%) of EDs are fully stocked with the recommended equipment, compared to 20% in previous reports.

More emergency departments are weighing patients in kilograms, which the author said is a valuable safety measure to ensure that children receive the proper dosage of medication.

However, more hospitals should specifically include children in their triage policy, the authors say. Only 62% of emergency departments said their triage policies specifically address children. The Emergency Nurses Association has developed a triage tool to assess pediatric patients.

Fewer hospitals are offering inpatient services for pediatric patients, and that’s placing more strain on regional pediatric hospitals, the authors note.

The number of hospitals reporting pediatric intensive care unit beds fell from 12.5% to 9.7% since the 2013 study. Less than one-third of hospitals (30.8%) maintain pediatric inpatient ward beds, compared to 53.4% in 2013.

Terry Foster, president of the Emergency Nurses Association (Photo: ENA)

With more children and teens being transferred to regional pediatric hospitals, the authors say the need for improved readiness for pediatric care in the emergency department has become “even more relevant.”

Children account for one in four emergency department visits, the study notes.

“To treat children accurately in the ED takes not only specialized equipment but appropriate knowledge and policies,” Terry Foster, president of the Emergency Nurses Association, said in a statement. “It’s imperative that everyone in the ED is committed to improving pediatric care especially with the ongoing pediatric mental health crisis and boarding issues.”

Many hospital leaders and physicians say they have seen a sharp rise in pediatric patients needing hospitalization due to mental health issues.