July 30, 2022
In this article, Terri A. Elsbernd, M.S., R.N., pediatric trauma coordinator at Mayo Clinic in Minnesota with 30 years' trauma and emergency medicine experience, talks about the PedsReady program and its usefulness for your organization.
Who is behind PedsReady, and when did this program start?
This is a federal program with multiple organizations involved. It started in 2013.
What is the PedsReady policy statement? Were any significant steps taken after publication?
The statement is Pediatric Readiness in the Emergency Department. It's about assessing emergency departments' preparedness to receive children. From this publication, the National Pediatric Readiness Project (NPRP) launched the National Pediatric Readiness Assessment.
What is the assessment for and why is it needed?
It's a voluntary, unenforced quality improvement (QI) exercise to help hospitals self-assess their emergency departments' preparedness for pediatric patients. Every facility needs to get its score. The NPRP believes many hospitals, especially lower volume or critical access hospitals, may have limited resources, including gaps in child-specific equipment and training for pediatric emergency care. Having all necessary resources can be a burden on hospitals, especially as the majority of community emergency department patients are adults, not children. If you have low pediatric volumes, the lack of child-specific resources may go unnoticed until the facility has a bad case with a bad outcome.
Overall, pediatric preparedness is the area in which emergency departments nationwide have the biggest improvement opportunity.
Why don't we just modify our adult equipment, supplies and training for our pediatric emergency patients?
Unfortunately, this doesn't work. Children are more than just small adults. They're different in physiology, mentality and drug dosing, which health care providers compute based on weight for children. You can't take your adult program, cut it in half and say it's for kids. You also have to be knowledgeable about children of different ages, as care and assessments will be different. For example, vital signs for a 2-month-old and a 17-year-old won't be the same.
What could happen if we just modify our adult supplies and training for children?
Considering equipment, let's say a 3-year-old child comes into your emergency department and needs a chest tube. You can't use an adult size for that child. The patient needs pediatric-sized equipment. Failure to use a chest tube because it's too large can lead to serious consequences. It's the same with endotracheal tubes, which in adult size are bigger than children's airways.
Regarding training, health care providers need instruction on children's distinct anatomy and physiology. Children look different from adults in shock, for instance. For adults, you just look for blood pressure. Children, however, can maintain blood pressure until losing greater than 30% of their circulatory blood volume. So, you want to observe their heart rates first. Capillary refill and tachycardia are the best perfusion status indicators. When training for pediatric trauma care, we say tachycardia is shock till proved otherwise. You won't recognize that shock if all you are looking at is blood pressure.
If our facility takes this assessment, will NPRP make the results public? What if our score is not ideal?
No, it's not public at all. It's not required, and it's intended to help you make improvements. Once you receive your score, your hospital can use it for QI processes. That's what Mayo Clinic Hospital — Rochester, Saint Marys Campus, has done.
So, if you ask me what the PedsReady assessment score is for any given hospital, I won't know.
If your score is not ideal, the first thing to do is look at who filled out the assessment. It's possible they may not know all that's available at your facility.
Second, don't stick the assessment in a drawer, literally or figuratively. It's meant to help better your pediatric emergency preparedness.
What facilities receive this assessment, and how often?
The NPRP sends this assessment to every hospital on a semiregular basis and will continue to do so. For Minnesota, for instance, the participating hospital numbers were lower this last assessment. It's important to participate so your state's response rate is high, but especially to see where you need work to be ready for pediatric patients.
What individual at a hospital completes the assessment?
Usually, an emergency department nurse manager or medical director does this, or sometimes the trauma coordinator.
How have your hospital's staff responded to this assessment?
Our staff sees value in it to maintain Mayo Clinic's readiness over time and discover improvement opportunities. We completed one in 2021.
Why would our hospital want to participate?
It's immensely helpful for privately letting your hospital know where it's ready for pediatric emergency patients and where it needs work. For any score — high or low — it can prompt improvement efforts for any lacking areas.
It's important to avoid viewing this PedsReady assessment as punitive, but to identify your own challenges and areas for improvement.
If our hospital has limited resources, what should we address after this assessment?
If you can only do one thing to make improvements, choose the most important item, or select items you can check off quickly. Think low-effort, high-impact items. There really is a lot you can do for little money, but that still makes a big difference.
For example, one improvement we made previously at Mayo Clinic was to measure children's weight in kilograms, instead of pounds. Rather than spend money on new scales, we sent all scales to the Department of Facilities and Support Services at Mayo to disable readings in pounds.
Other improvements you might consider that wouldn't be expensive are improving pain assessments for children at your facility, or making children's care more family-centered by allowing families to attend their child's resuscitation. Or you might need to do a literature search to write a new guideline for your pediatric emergency care.
Overall, I'd say after you get your score, do what you can.
Does American College of Surgeons (ACS) have a role in this assessment or the PedsReady program?
Yes, the ACS has indicated that starting in 2023, each emergency department needs to evaluate its pediatric readiness and have a plan to improve deficiencies.
Any other thoughts on how to view the PedsReady assessment?
If your children or grandchildren came into your facility, wouldn't you want them to have a good outcome? Wouldn't you want to take care of your community?
For more information
Remick K, et al. Pediatric readiness in the emergency department. Pediatrics. 2018;142:e20182459.
National Pediatric Readiness Project: Ensuring Emergency Care for All Children. PedsReady.
Refer a patient to Mayo Clinic.