Why PEDS READY?

Critical Care, Education, Pediatrics

Written by Michael Wolf*

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In-hospital mortality was decreased in critically ill children presenting to the ED in hospitals with higher weighted pediatric readiness scores (WPRS).

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Why does this matter?
Children account for 20% of ED visits in the United States, with pediatric EDs accounting for a minority of these visits. We know that “pediatric readiness” varies between hospitals. What does this mean for children presenting with critical illness?

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Ready or not…
Over 20,000 episodes of pediatric critical illness were identified in two databases representing 426 hospitals in five diverse U.S. states. Pediatric readiness was calculated using the WPRS, a validated scale noting the presence or absence of key hospital factors. In broad strokes, these included pediatric-specific physician and nurse coordinators, periodic competency evaluation programs, a formal quality improvement review process, the practice of recording temperature, heart rate, respiratory rate and weight in kilograms for every child, availability of pediatric-specific airway, IV, and other equipment, and formal transfer protocols. Hospitals with lower WPRS tended to be smaller, non-teaching, located in smaller communities, and were less likely to have a pediatric ED or PICU. Unadjusted mortality was 3.4% for the highest, and 11.1% for the lowest WPRS quartile. Adjusting for age, severity, and complexity of presentation, presenting to a hospital with WPRS in the highest quartile was associated with lower in-hospital mortality (aOR 0.25, p <0.001). Inter-hospital collaboration, education, and appointment of coordinators might help to address gaps in pediatric readiness.

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Source
Emergency Department Pediatric Readiness and Mortality in Critically Ill Children.  Pediatrics. 2019 Sep;144(3). pii: e20190568. doi: 10.1542/peds.2019-0568.