SGEM #425: Are You Ready for This? Pediatric Readiness of Emergency Departments

Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children's National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis.  Guest Authors:  Dr. Kate Remick Dr. Kate Remick is a pediatric emergency medicine physician and Assistant Professor of Pediatrics at Dell Medical School at the University of Texas at Austin. She is an executive lead for the EMS for Children Innovation and Improvement Center. She has held leadership positions with state and national professional organizations to promote high quality emergency care for children. Dr. Hilary Hewes is a pediatric emergency medicine physician and an Associate Professor of Pediatrics at the University of Utah/Primary Children’s Hospital with interests in prehospital care, pediatric trauma and injury prevention, and disaster medicine and preparedness.  She is the co-Principal Investigator for the EMS for Children Data Center. Dr. Hilary Hewes Dr. Marianne Gausche-Hill is a pediatric emergency medicine physician and the interim CEO of the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center. She is also a Professor of Pediatrics and Emergency Medicine at David Geffen School of Medicine at UCLA. She is nationally known for her work as an EMS researcher and educator.  Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. She says that they’ve noticed a slight increase in the number of sick pediatric patients coming in recently and the difficulty in finding a hospital to accept the ones who need admission. As a seasoned clinician, she wants your opinion and asks you, “How prepared do you think we are in handling sick children?” and “Do you have any thoughts about how we can improve?” Dr. Marianne Gausche-Hill Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. One of the key motivations was the recognition that we needed to get out of the ivory towers of academic pediatric emergency medicine centers as most children are cared for outside of academic centers. We wanted to spread the gospel of evidence-based medicine so that children get the best care, based on the best evidence, regardless of where they receive care.  But does that always happen? Are general emergency departments ready to care for children? Two previous studies conducted assessing the state of nationwide pediatric readiness were conducted in 2003 and 2013. [1,2] Today we're covering the third study. Pediatric readiness is important because it is associated with decreased mortality in ill and injured children. [3, 4] Conflict of Interest Disclosure: Dennis is an Emergency Medical Services for Children (EMSC) fellow in the Knowledge Management domain.    Clinical Question: What was the state of pediatric readiness in emergency departments across the United States during the COVID-19 pandemic? Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Population: ED leadership across the United States. It included 3,647 readiness assessments performed, representing 14.1 million annual pediatric ED visits.  Excluded:  EDs that are not open 24 hours a day or 7 days a week. Veterans Affairs and prison hospitals. Intervention: Web-based open assessment questionnaire containing 92 questions.  Comparison: Previous pediatric readiness scores.  Outcome: Primary Outcome: Weighted pediatric readiness score (WPRS, range 0-100); Adjusted WPRS (exclude points for QI plan and Pediatric Emergency Care Coordinator aka PECC) Secondary Outcomes: Changes in WPRS from 2013 to 2021,