September 5, 2019

A new study found critically ill children have higher mortality rates when hospital EDs are not prepared for pediatric patients—but Jeremy Kahn, a fellow at the University of Pittsburgh and the study's senior author, said there are steps hospitals can take to better prepare for pediatric emergencies.

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About the study

For the study, Kahn, along with colleagues from the University of Pittsburgh and University of California, Los Angeles examined ED and inpatient records representing 20,483 critically ill children who presented at 462 hospitals in Florida, Iowa, Massachusetts, Nebraska, and New York. The researchers found that when a hospital's ED isn't equipped for pediatric patients, critically ill children were three times more likely to die than when brought to a hospital that's prepared.

According to Kahn, many hospitals aren't ready for pediatric emergencies in large part because they don't see high volumes of pediatric patients. "The vast majority of hospitals in the United States care for very small volumes of children, and when you have those low numbers, it's very hard to be ready for anything that can come your way. … So, the resource investment required to prepare for every eventuality for every pediatric emergency is enormous," he said.

How hospitals can better prepare

However, Khan said there are actions hospitals can take to better prepare for pediatric patients requiring emergency care. He explained that hospitals that scored low for pediatric readiness had the right equipment to treat pediatric patients, but lacked "a pediatric-focused quality improvement officer" and didn't have "all the policies and procedures in place."

In fact, he added that "the highest determinant [of pediatric readiness] was having a dedicated physician and nurse who oversee pediatric-focused quality improvement in the hospital."

To become prepared for pediatric emergencies, hospitals should "take a multipronged approach that customizes for a region or a … state," Kahn said. He added, "In some areas where there are no specialized children's hospitals, it may behoove that area for every hospital to be ready to care for children. But in other areas, maybe there are alternative strategies, such as regionalization, where the sickest children are triaged in the pre-hospital setting to go right to the one or two hospitals in the region that are most ready to care for pediatric emergencies."

Kahn added that telemedicine could also help "extend the benefits of pediatric readiness to more hospitals using remote audio-visual equipment."

In addition, Kahn advises hospitals to do a "readiness assessment" to "know what their capabilities are for caring for critically ill children." Preparing for pediatric patients requires "a very customized approach," Kahn said. "There's not going to be a one-size-fits-all approach."

He added that the responsibility shouldn't fall on the individual clinicians to get their hospital pediatric ready. "This is a systemwide issue, and hospitals and regions within states should get together to strategize about the best ways to deliver emergency care for children" (Commins, HealthLeaders Media, 8/29; Ames et al., Pediatrics, September 2019).

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