Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin.
National Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas.
JAMA Netw Open. 2023 Jul 3;6(7):e2321707. doi: 10.1001/jamanetworkopen.2023.21707.
The National Pediatric Readiness Project assessment provides a comprehensive evaluation of the readiness of US emergency departments (EDs) to care for children. Increased pediatric readiness has been shown to improve survival for children with critical illness and injury.
To complete a third assessment of pediatric readiness of US EDs during the COVID-19 pandemic, to examine changes in pediatric readiness from 2013 to 2021, and to evaluate factors associated with current pediatric readiness.
DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a 92-question web-based open assessment of ED leadership in US hospitals (excluding EDs not open 24 h/d and 7 d/wk) was sent via email. Data were collected from May to August 2021.
Weighted pediatric readiness score (WPRS) (range, 0-100, with higher scores indicating higher readiness); adjusted WPRS (ie, normalized to 100 points), calculated excluding points received for presence of a pediatric emergency care coordinator (PECC) and quality improvement (QI) plan.
Of the 5150 assessments sent to ED leadership, 3647 (70.8%) responded, representing 14.1 million annual pediatric ED visits. A total of 3557 responses (97.5%) contained all scored items and were included in the analysis. The majority of EDs (2895 [81.4%]) treated fewer than 10 children per day. The median (IQR) WPRS was 69.5 (59.0-84.0). Comparing common data elements from the 2013 and 2021 NPRP assessments demonstrated a reduction in median WPRS (72.1 vs 70.5), yet improvements across all domains of readiness were noted except in the administration and coordination domain (ie, PECCs), which significantly decreased. The presence of both PECCs was associated with a higher adjusted median (IQR) WPRS (90.5 [81.4-96.4]) compared with no PECC (74.2 [66.2-82.5]) across all pediatric volume categories (P < .001). Other factors associated with higher pediatric readiness included a full pediatric QI plan vs no plan (adjusted median [IQR] WPRS: 89.8 [76.9-96.7] vs 65.1 [57.7-72.8]; P < .001) and staffing with board-certified emergency medicine and/or pediatric emergency medicine physicians vs none (median [IQR] WPRS: 71.5 [61.0-85.1] vs 62.0 [54.3-76.0; P < .001).
These data demonstrate improvements in key domains of pediatric readiness despite losses in the health care workforce, including PECCs, during the COVID-19 pandemic, and suggest organizational changes in EDs to maintain pediatric readiness.
国家儿科准备项目评估提供了对美国急诊科（ED）照顾儿童能力的全面评估。增加儿科准备已被证明可以提高患有危急疾病和伤害的儿童的生存率。
在 COVID-19 大流行期间完成对美国 ED 儿科准备情况的第三次评估，检查从 2013 年到 2021 年儿科准备情况的变化，并评估与当前儿科准备情况相关的因素。
设计、地点和参与者：在这项调查研究中，对美国医院（不包括每天 24 小时/每周 7 天开放的 ED）的 ED 领导层进行了一项 92 个问题的基于网络的开放式评估。数据于 2021 年 5 月至 8 月收集。
加权儿科准备评分（WPRS）（范围为 0-100，分数越高表示准备程度越高）；调整后的 WPRS（即，归一化为 100 分），排除存在儿科急诊护理协调员（PECC）和质量改进（QI）计划所获得的分数进行计算。
向 ED 领导层发送了 5150 份评估，其中 3647 份（70.8%）做出了回应，代表每年有 1410 万儿科 ED 就诊。共有 3557 份（97.5%）回复包含所有评分项目，并纳入了分析。大多数 ED（2895 [81.4%]）每天治疗的儿童少于 10 人。中位数（IQR）WPRS 为 69.5（59.0-84.0）。比较 2013 年和 2021 年 NPRP 评估的常见数据元素表明，中位数 WPRS 有所降低（72.1 与 70.5），但除了在管理和协调领域（即，PECC）显著下降外，所有准备领域都有所改善。在所有儿科量类别中，存在 PECC 与调整后的中位数（IQR）WPRS 较高（90.5 [81.4-96.4]）相关，而没有 PECC 则为 74.2 [66.2-82.5]（所有 P 值均<.001）。其他与更高儿科准备相关的因素包括拥有完整的儿科 QI 计划与没有计划（调整后的中位数 [IQR] WPRS：89.8 [76.9-96.7]与 65.1 [57.7-72.8]；P<.001）和配备经过董事会认证的急诊医学和/或儿科急诊医学医师与没有配备（中位数 [IQR] WPRS：71.5 [61.0-85.1]与 62.0 [54.3-76.0；P<.001）。
这些数据表明，尽管在 COVID-19 大流行期间医疗保健劳动力（包括 PECC）流失，但儿科准备的关键领域仍有所改善，并表明 ED 进行了组织变革以维持儿科准备。
