Newsletters

POSTED: March 15th, 2023
POSTED IN: 2023 Quarter 1, EM Pulse - The Official Newsletter of MOCEP, Legislative Updates,

Written by: Danielle Lee, EMT-P, MOEMSC Program Manager; Keven Cutler, MD, MBA, FAAP, FACEP, MOCEP Board Member

Research demonstrates that pediatric readiness significantly reduces morbidity and mortality in ill or injured young patients, especially younger children; such preparation improves both emergency provider comfort, and appropriateness of care in children in all settings. Furthermore, pediatric patients receiving acute emergency care at non-tertiary care centers may especially benefit.

In 2018, the American Academy of Pediatrics (AAP) released a joint policy statement; The organizational principles to guide and define the Child Health Care system and/or improve the health of all children. This was a revision of the prior joint policy statement, Guidelines for the care of children in emergency medicine. In the updated Policy Statement, AAP and other partner organizations address recommendations for resources to prepare the emergency department to care for a pediatric patient. Adoption of the recommendations in the Policy Statement will increase the quality of emergency care for children of all ages. The National Pediatric Readiness Survey was drafted to quantify the pediatric readiness of emergency departments in the United States.  

The state of emergency department pediatric readiness in Missouri

Pediatric readiness simply means the systematic inclusion of pediatric-specific needs into all aspects of emergency department (ED) care.   The National Pediatric Readiness Project (NPRP) survey is designed for providers and hospital facilities to inventory themselves over several different categories, such as personnel, quality improvement, patient safety and care, disaster planning, equipment, and local coordination of care.  The NPRP was completed by 81% (91/113) of Missouri emergency departments in 2021; generally, the average Missouri pediatric readiness score was 67/100.  More specifically, about 80% of pediatric patients are seen in community and general emergency departments, and around 50% are seen in EDs with a low pediatric volume (fewer than 5 pediatric patients per day). The median score for Missouri emergency departments seeing less than 5 children a day had an average score of 61/100. Please see the full state summary report for analysis of scores. 

Establishing a pediatric emergency care coordinator (PECC) in the emergency department is a critical first step on improving pediatric readiness. The PECC advocates for and oversees pediatric specific training and quality, and the inclusion of pediatric specific supplies into a general emergency department. Currently only 25% of emergency departments in Missouri identified as having a PECC.

What is Missouri EMSC doing to improve statewide pediatric readiness in emergency care? Currently Missouri EMSC has developed a pediatric facility recognition program for all emergency departments in Missouri. Missouri Pediatric Excellence in Emergency Care (MO-PEEC) had developed criteria to increase pediatric readiness in Missouri emergency departments. The criteria were developed from the recommendations of the NPRP survey and the 2018 Joint Policy Statement – Pediatric Readiness in the Emergency Department, which details the criteria a must meet to be recognized through the MO-PECC program This is a three-tier program, each tier is based off the pediatric resources available at the hospital applying. 

Pediatric Emergency Champion PEC: Tier I– A hospital with extensive pediatric resources, must include a PICU and NICU. 

Pediatric Emergency Prepared PEP: Tier II- A hospital with some pediatric capabilities such as level II nursery, OB and/or Pediatric in-patient.

Pediatric Emergency Ready PER: Tier III –Critical Access Hospital or Community Level ED with limited inpatient capabilities for pediatrics and level one nurseries.  

Here is a short screening tool to assess your pediatric readiness within your emergency department. If you answer no to any of the following questions and would like help with your pediatric readiness please contact [email protected] or fill out the NPRP for your emergency department here www.pedsready.org.

1. Has your emergency department completed their NPRP survey in 2021? 
2. Does your emergency department have a PECC? 
3. Does your emergency department have a triage policy for children? 
4. Does your emergency department have disaster plans that include kids? 

If you are a physician or provider in the ER and want to review your 2021 NPRP gap report, or interested in the MO-PECC program through EMSC please contact [email protected] or fill out the NPRP for your emergency department here www.pedsready.org.  

MOCEP has recently established a Pediatric Emergency Medicine (PEM) Committee to specifically address the needs of children.  The committee welcomes your participation as it advocates for pediatric emergency care and develops an online resource for providers to better serve their young patients.  If you would like to become involved, please contact MOCEP PEM Committee Chairman, Mary Beth Bernardin MD, [email protected] , or Sarah Luebbert, APR, MOCEP Executive Director, [email protected].

Additional Materials:

Facility Recognition Collaborative (FRC) • EIIC (emscimprovement.center)

Readiness Checklist & Toolkit • EIIC (emscimprovement.center)

State gap report for Missouri (see file below)

References:

Foster, Ashley A., and Jennifer A. Hoffmann. Saving Children’s Lives by Improving Pediatric Readiness for Emergency Care.  JAMA Open Network, vol. 6, no. 1, 2023,

Kothari, Shikha Yashwant, et al. “Resources for Improving Pediatric Readiness and Quality of Care in Rural Communities and Emergency Departments.”  Pediatric Emergency Care, vol. 38, no. 3, 2022.

Newgard, Craig D., et al. Evaluation of Emergency Department Pediatric Readiness and Outcomes Among Us Trauma Centers.JAMA Pediatrics, vol. 175, no. 9, 2021, p. 947.,