Critically ill children brought to hospital emergency departments that are ill-prepare to care for pediatric emergencies have more than three times the odds of dying compared to those brought to hospitals well equipped to care for them; so according to an analysis led by University of Pittsburgh and University of California-Los Angeles physician scientists.
The findings, published today in the journal Pediatrics; which are the first to provide evidence; hence from multiple states linking the readiness of hospital emergency departments to care for critically ill or injure children with outcomes; also could guide a variety of policy responses. “Pediatric care requires specialized equipment, training; also protocols to provide the best care to children.
Obtaining that kind of preparedness is costly and time consuming,” said senior author Jeremy Kahn, M.D., M.S., professor in the Department of Critical Care Medicine at Pitt’s School of Medicine and the Department of Health Policy and Management at Pitt’s Graduate School of Public Health. “Our study suggests that efforts to better prepare hospitals to care for pediatric emergencies save lives.”
Kahn and his colleagues obtained data from 426 hospitals in Florida, Iowa, Massachusetts; Nebraska and New York, on 20,483 critically ill patients age 18 or younger who were brought to the hospital emergency department. They cross-referenced the patient outcomes with the “pediatric readiness” of the hospital’s emergency department.
Hospital pediatric readiness
Pediatric readiness is indicated by a score assigned following assessment by the National Pediatric Readiness Project, a quality improvement effort of several federal government and non-profit advocacy organizations. Hospitals receive higher scores based on several factors, including whether they have equipment designed for use on children, pediatric specific protocols for medical procedures and care, and educational programming to keep clinicians up-to-date on the latest guidelines in pediatric care. The standardize readiness score ranges from 0 to 100.
A hospital’s pediatric readiness should be a factor in determining to; which hospital a critically ill child should be transport. There likely isn’t one perfect solution to the disparity in outcomes, noted lead author stefanie Ames, M.D., M.S. pediatrician specializing in critical care medicine at UCLA Mattel Children’s Hospital and assistant professor in the Division of Pediatric Critical Care at UCLA David Geffen School of Medicine.
“Should we focus only on improving the pediatric readiness of all hospitals; potentially investing money and resources in hospitals that rarely see children? Or should we do more to direct pediatric emergencies to hospitals well equipped to care for them; so potentially increasing transport times?” she asked. “Some combination will likely be need and potential solutions; which also could incorporate telemedicine and processes to promote quick recognition and transfer of pediatric emergencies to more prepared hospitals.”