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Pediatric Readiness: A Best Practice for Pediatric Trauma Care
Katherine Remick, MD, FAAP, Dell Children's Medical Center, Austin TX; Jocelyn Hulbert, Emergency Medical Services for Children Program--Health Resources and Services Administration, Rockville MD; Diana Fendya, MSN (R), RN, EMS for Children Program National Resource Center Children's National Health System, Washington DC; Emily Sullivan, MPH, MS, EMS for Children Data Analyst Resource Center Salt Lake City, UT

Abstract: INTRODUCTION AND BACKGROUND: Resources for Optimal Care of the injured Patient delineates essential obligatory requirements for trauma centers. The 2009 “Guidelines for Care of Children in the Emergency Department” defines essential components for emergency departments caring for children. An assessment of over 4,000 US Emergency Departments was conducted evaluating national compliance with the guidelines or pediatric readiness while also identifying gaps/areas for improvement. METHODS: All ED nurse managers, excluding Veteran’s Administration, prison hospitals, and hospitals without an ED 24/7, were sent a 55-question web-based assessment tool. A modified Delphi process generated a weighted pediatric readiness score (WPRS). Upon completion of the assessment participating EDs received immediate feedback including a WPRS, benchmarking, a gap analysis and summary report. RESULTS: 5,017 assessments were sent to U.S. hospitals having EDs. Over 4,100 (82.7%) facilities responded, representing 24 million pediatric ED visits. The median WPRS was 69 (IQR; 56.1-83.6). Identified gaps included pediatric specific quality improvement plans, availability of inter facility transfer agreements and guidelines, disaster plans integrating the needs of children and presence/identification of physician/nurse pediatric emergency care coordinators (PECC). A subgroup analysis of California EDs illustrated Level I/II trauma centers had higher WPRS, 87.4 [IQR 69-94] than level III/IV trauma centers, 64.8 [IQR 53-83] and non-trauma centers, 68.1 [IQR 57-82], p<0.0001. However, when controlling for pediatric verification and annual pediatric patient volume, trauma center designation was no longer predictive of the WPRS (p=0.06). IMPLICATIONS: Assessment findings provide unique opportunities for hospitals, whether trauma or non-trauma facilities, to improve their pediatric readiness capabilities.

Objective: Identify at least 1 opportunity for improving pediatric readiness capacity in attendee's own emergency department.

Objective Content: I Define the value of the pediatric readiness assessment and findings linking results to every emergency department's ability to provide optimal pediatric trauma care. A. Discuss major pediatric readiness assessment findings. B. Discuss potential gaps in ability to provide optimal pediatric trauma care as a result of EDs not being pediatric ready. II. Identify natural intersects for improving pediatric readiness capabilities that can cross over to assuring optimal pediatric trauma care.


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