In emergencies, children have distinct needs because of their unique physiological, emotional and developmental characteristics. But 83% of emergency departments nationwide are not fully prepared to meet those needs — which can be life-threatening for a child in cases of severe illness or injury.
A new Oregon Health & Science University-led study, published today in JAMA Network Open, found that bridging that gap, known as becoming "pediatric ready," could prevent the deaths of more than 2,100 children each year with modest financial investment.
In Oregon specifically, an investment of just over $3 per child — a total cost of about $2.7 million annually — could save approximately 30 children's lives each year when adjusted for population size.
"Few topics are more important than children and their health. We need to do everything we can to keep them alive, and improving pediatric ED readiness is one significant way to move the needle," said Craig Newgard, M.D., M.P.H., professor of emergency medicine in the OHSU School of Medicine and lead author of the study. "This study builds on a growing body of research demonstrating that every hospital can and must be ready for children's emergencies.
"For the first time, we have comprehensive national and state-by-state data that emphasizes both the urgency and feasibility of this work."
Saving lives with readiness
The research team, co-led by Newgard and Nathan Kuppermann, M.D., chair of pediatrics and chief academic officer at Children's National Hospital, analyzed data from 4,840 emergency departments, focusing on 669,019 children at risk for death upon seeking care. Using predictive models, they assessed how every emergency department achieving high pediatric readiness — defined as scoring at least 88 out of 100 on the National Pediatric Readiness Project, or NPRP, assessment — could impact mortality rates.
By applying the potential reduction in mortality associated with high readiness to the number of at-risk children and adjusting state-specific estimates for population size, the researchers identified the number of lives that could be saved each year: Of the 7,619 children who die annually while receiving emergency services, 2,143 lives could have been saved through universal high ED pediatric readiness.
The study authors emphasize that modest investment in health care dollars would be needed to eliminate these inequities in pediatric emergency care: The cost per child resident by state ranges from $0 to $12, a price tag lower than a single dose of most routine childhood vaccines.
They also outline several strategies to improve pediatric emergency care, such as integrating high pediatric readiness into hospital accreditation requirements and incentivizing readiness through performance-based reimbursement models.
"This research emphasizes the urgent need for widespread investment in pediatric readiness," said Kate Remick, M.D., co-author of the study and emergency physician at the Dell School of Medicine at the University of Texas at Austin. "The National Pediatric Readiness Project has provided a roadmap for improvement. But we need the full engagement of clinicians, health care administrators, policymakers, and families to make universal pediatric readiness a reality."
Ready, able to save a child's life
On a high level, readiness of emergency departments represents the ability to care for acutely ill and injured children. In practice, achieving high pediatric ED readiness includes elements such as care coordination, personnel, quality improvement, safety, equipment, and policies and procedures.
To support hospitals' efforts, the NPRP has developed free, open-access resources for ED providers and staff to help facilitate delivery of high-quality emergency care to all children. The Emergency Medical Services for Children Program also provides individualized resources, including program administrators in all 50 states who are able to guide hospitals through readiness work based on their state's unique health care needs and landscape.
Understanding the significant geographic barriers many individuals face to receive care, upcoming research by Newgard and colleagues will focus on rural emergency care and how hospitals can better serve children living in rural and frontier areas. The research team will also continue to investigate the economic benefits of pediatric ED readiness, including long-term health system savings.
"The vast majority of kids — more than 80% — who present for care at emergency departments across the country are cared for outside of children's hospitals, primarily in general community EDs," Newgard said.
"What's so impactful about the concept of readiness is that it's designed to be inclusive of all hospitals regardless of size, resources, geography or other constraints," he added. "It's well within our reach to ensure every hospital is ready and able to save a child's life."
The research was supported by a Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Emergency Medical Services for Children Targeted Issue grant (H34MC33243-01-01) and an HHS National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant (R24 HD085927). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HHS, HRSA, NIH, or the U.S. Government.
