Can Children's Deaths Be Prevented in Emergency Rooms? Study Provides Insight

New research indicates emergency departments that are prepared to see children—or have a high degree of pediatric readiness—have lower mortality rates among pediatric patients than those that are ill-prepared. This is according to a study funded by the National Institutes of Health.

"The initial care a child gets at the ER sets them on a pathway to survival, or not making it," saysCraig Newgard, MD, MPH, the lead researcher on the study and the director of the Center for Policy and Research in Emergency Medicine (CPREM).

In fact, those first 24 hours are crucial, Dr. Newgard says. Even if a child is later transferred to a more-prepared emergency department, the first emergency room they visit plays a critical role in their survival. That's why it is so important that all hospitals be prepared in order to save kids' lives.

Lower Chance of Children Dying in Prepared ERs

Children make up more than 30 million emergency department visits each year, with more than 97% of those visits in non-children’s hospitals. Yet, previous studies have shown that hospitals' pediatric readiness varies widely in the U.S.

Consequently, researchers wanted to see what type of impact pediatric readiness could have on child survival rates. They launched a six-year study involving nearly 800,000 children. What they discovered is more than 1,400 children’s deaths could have been prevented if hospital emergency departments had adopted national pediatric care readiness standards, as defined by the National Pediatric Readiness Project (NPRP).

They also found thatchildren with injuriestreated in high-readiness emergency departments had a 60% lower chance of dying, while children with anillnesshad a 76% lower chance of dying.When emergency departments are prepared for and ready to see pediatric patients, more children will be able to be saved, Dr. Newgard adds.

"This study’s findings provide evidence that children cared for in emergency departments with high pediatric readiness standards have a lower risk of death after critical illness or injury," saysCinnamon Dixon, DO, MPH, a medical officer in the NICHD Pediatric Trauma and Critical Illness Branch. "Implementing robust pediatric readiness standards will help save the lives of the children they serve.”

What Is the National Pediatric Readiness Project?

The NPRP was created as a national quality improvement initiative to better the consistency of care for children in the country's emergency departments.The project was co-led by the Health Resources Services Administration (HRSA), Emergency Medical Services for Children (EMSC) Program, theAmerican Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association,

A critical part of the NPRP is increasing pediatric readiness in emergency rooms, says Dr. Newgard. This is accomplished by addressing care coordination, personnel and competencies, quality improvement, patient safety, policies and procedures, and availability of key equipment and supplies.

"The goal of the project—which was started three decades ago—is to ensure that every child has access to high-quality emergency care," saysKatherine Remick, MD, FAAP, FACEP, FAEMS, co-director of the National EMS for Children Innovation and Improvement Center and executive director of the National Pediatric Readiness Quality Initiative. "Kids die when emergency rooms are not prepared, The staff may know what needs to be done, but they are not prepared to do it."

When the readiness project was introduced, Dr. Remick says they had an enormously high rate of response. "In fact, 82% of hospitals in the country took the assessment. And, this is not a simple assessment—it is a 100-question assessment."

This level of interest shows that the majority of hospitals in the country want to do better and make sure they are adequately prepared to see pediatric patients, she says.

"The pediatric readiness survey was designed to help educate and increase awareness for adult facilities of the importance of being prepared for pediatric patients," saysLaura Pollauf, MD, FAAP, a pediatrician and director of the division of pediatric emergency medicine at Akron Children's Hospital. "The goal is to ensure they have appropriate pediatric equipment to manage emergencies and have a dedicated pediatric liaison or Pediatric Emergency Care Coordinator to ensure the care team has appropriate training and equipment."

How Can Hospitals Meet Pediatric Readiness Standards?

Participation in the NPRP is fairly simple for any hospital that wants to join. The program is not an enrollment project and there are no fees or registration. Hospitals just need to have the desire to make sure they are ready for pediatric patients, Dr. Remick says.

"Most hospital emergency departments were designed with adults in mind," Dr. Remick adds. "But pediatric readiness does not mean these hospitals must have high-level resources. It's about having the basic requirements in place to meet the needs of children."

The biggest push is to raise the level of preparedness so that every emergency department is ready, Dr. Newgard says.

"It is not realistic to build pediatric trauma centers in every city," Dr. Newgard explains. "But we can use the existing network [of hospitals] and bolster those emergency departments and save more children's lives."

Plus, when parents take their child to the emergency room, they assume that the hospital can handle the emergency, Dr. Remick adds. There is a public expectation they will be able to meet the needs of any patient.

Has My Hospital Adopted Pediatric Readiness Standards?

Because the NPRP is a volunteer program and filling out the assessment is confidential, there is no way to determine whether your nearest hospital is prepared to see children. That said, you can contact your local hospital and ask what they have done to prepare for seeing kids in your community.

The good news is that 80% of hospitals are involved with the pediatric readiness program, Dr. Remick says. They are making strides toward further improvement.

"Eighteen states have pediatric recognition programs in place," she adds. "Most often, these are hosted by the state's EMS Programs. In most of these states, the hospitals prepared for pediatric patients get a decal for their doors. If a parent sees this decal, they can feel pretty good about taking their child there."

The EMSC program also has a representative for every state you can contact for more information, Dr. Newgard says. Parents also can check with their state's department of health to determine the readiness of the emergency departments in their area. Or, they can ask to speak to their hospital's emergency room leadership.

如果父母发现their hospitals are not prepared for pediatric patients, they also can advocate for change with their state and federal representatives, he adds. "People also can send their local hospital the links to theNPRP checklist and toolkit. It is a great resource and very consumable information."

重要的是要记住的时候很多俄文ral hospitals are closing their doors due to lack of resources, we don't want to penalize hospitals for not implementing readiness standards, Dr. Remick says, adding: "Some access is better than no access. But we can do a lot better."