COVID-19 Pandemic Reduced US Emergency Department Pediatric Readiness

An assessment published in JAMA Network Open on national pediatric readiness in United States emergency departments (ED) found that the COVID-19 pandemic reduced readiness. However, additional evaluations maintain that the healthcare system continues to work toward improved readiness.  

Researchers looked at pediatric readiness before and during the COVID-19 pandemic, emphasizing the period from 2013 to 2021. To evaluate readiness, ED leaders of US hospitals with a 24/7 ED were surveyed using a 92-question web-based assessment. The survey responses were submitted between May 2021 and August 2021.  

Over 3500 assessments were evaluated, accounting for a 97.5% response rate. Roughly 81.4% of hospital EDs treated a low or medium volume of pediatric patients daily. Overall, the data evaluated 14.1 million pediatric ED visits.  

Approximately 76.5% of respondents admitted pediatric patients; 48.8% admitted children to adult in-patient units. Despite 57.9% of respondents having neonatal inpatient services, less than one-third had pediatric in-patient ward services, and only 9.7% had pediatric intensive care units (PICU).  

The study also found that only 14.1% of ED departments evaluated required a board-certified pediatric emergency medicine healthcare provider. 

The investigators evaluated pediatric readiness using weighted pediatric readiness scores. The scale was scored between 0 and 100. Higher scores were linked to having pediatric emergency care coordinators (PECCs), quality improvement plans, and board-certified emergency medicine or pediatric emergency medicine physicians. 

The average pediatric readiness score was 69.5, ranging between 59.0 and 84.0. The readiness score was higher for facilities that treated more pediatric patients.  

“During the eight years since the last national assessment, all domains of readiness have increased except administration in the ED (i.e., PECCs), which declined significantly. Although the role of the PECC is central to improving pediatric readiness, stressors on the healthcare sector and its workforce have undoubtedly played a role in reducing the assignment of physician and nurse personnel to this role,” researchers noted in the publication.  

“This comprehensive assessment found that the presence of PECCs, QI plans for children, and staffing the ED with board-certified EM/PEM physicians were associated with higher pediatric readiness and provides an opportunity for all EDs to initiate organizational changes that can enhance their pediatric capability.”