Four steps to comply with pediatric readiness standards

Authored by:  
Bill Briggs, MSN, RN, CEN, TCRN, NEA-BC, FAEN
Vice President and Managing Partner

Many emergency department (ED) and trauma staff say their greatest fear is caring for a critically ill or injured child. Caregivers often bring children in without prior notification since they are small and portable. This becomes even more stressful for staff in adult EDs, where pediatric cases are rare.

Pediatric Readiness Standard

In the 2022 edition of Resources for Optimal Care of the Injured Patient, the American College of Surgeons added a new standard, 5.10 Pediatric Readiness which states:

“In all trauma centers, each emergency department must perform a pediatric readiness assessment during the verification cycle and have a plan to address identified gaps.”

The standard further specifies that the pediatric readiness assessment and plan must cover the following six areas:

  • Infrastructure
  • Administration and coordination of care
  • Personnel
  • Pediatric specific policies
  • Equipment
  • Other resources that ensure the center is prepared to provide care for an injured child.

The pediatric readiness standard is based on strong evidence on the care of children. Most injured children are treated in non-pediatric hospitals. In a study of 372,000 children treated in 832 emergency departments, Newgard (2021) reported a 58% reduction in risk-adjusted mortality. Another large study (Remick, 2019) revealed that trauma hospitals do not have higher pediatric readiness scores than the national average.

Step 1: Pediatric Readiness Assessment (PRA)

The Pediatric Readiness Assessment (PRA) is a self-evaluation tool that helps emergency departments (EDs) determine their readiness to care for ill and injured children. Survey questions are weighted based on their importance.

Before proceeding, check with your ED to see if the PRA has already been completed and if results are available. If not, you can request them from your state agency. Your state agency and EMS-C Program Manager can be found at www.emscdatacenter.org.

If the PRA has not been conducted or is outdated, coordinate with ED leadership to complete the assessment. It is available through your state’s EMS-C office or online at www.pedsready.org. To streamline the process, consider printing a paper copy first to organize the necessary information before submitting it online.

The assessment must be completed within the three-year ACS trauma verification cycle. Starting early is recommended to ensure you receive your results and develop an action plan before your ACS Pre-Review Questionnaire (PRQ) is due.

Step 2: Review the assessment results.

The results will include your pediatric readiness score along with scores for each section. Review the report carefully, as the weighted scores will help you identify the most critical areas to focus on in your remediation plan. Generally, having both a physician and nurse champion for the program, along with implementing a performance improvement program, will yield the best results.

Step 3: Assist the ED in making an action plan

Although Pediatric Readiness primarily addresses care in the ED, the trauma program is a key stakeholder. Work with ED leadership to address the gaps in pediatric care. The results of the PRA will guide you. Additionally, many references and a toolkit available on: www.emscimprovement.center/domains/pediatric-readiness-project/readiness-toolkit/. 

Step 4: Assure you have all the documentation ready

At a minimum, you need to have your PRA results ready to submit, along with your plan for addressing deficiencies. Additionally, demonstrating progress with performance improvement data, meeting minutes, etc., will support your compliance with the standard. Staff should be prepared to discuss the care of children, including their training, available equipment, policies and guidelines in place, and how improvements are carried out and communicated in the ED. Transfer agreements are part of the PRQ and will need to be submitted.

Tips for improving care of the injured child

  • Make sure that you are a trusted ally of the ED leadership rather than someone that is placing addition burdens on them. Your expertise as a trauma program manager or PI coordinator should be invaluable to them.
  • Partner with the pediatric hospital and trauma center you commonly transfer your patients to. They can provide you with pediatric guidelines, education, sources of specialty equipment, and much more. 
  • When assessing equipment needs, go beyond the list in the PRA and consider what the injured child might need such as chest tubes, warming devices, cervical collars, nasogastric tubes, Foley catheters, surgical airway devices, etc.
  • In some circumstances, the pediatric patient may need emergency damage control surgery. Ensure the operating room has the necessary equipment.

The Pediatric Readiness standard may be easier to comply with than others, as the assessment is already provided and the remediation plan is available online. Starting early and helping the ED address deficienciesI h in the PRA will ensure that you meet the standard. Moreover, you will be contributing to saving the lives of injured and ill children.

References

Newgard, CD et al. Evaluation of Emergency Department Pediatric Readiness and Outcomes Among US Trauma Centers. JAMA Pediatrics. 2021;175(9):947-956.

Remick K, Gaines B, Ely M, Richards R, Fendya D, Edgerton EA. Pediatric emergency department readiness among US trauma hospitals. J Trauma Acute Care Surg. 2019 May;86(5):803-809. doi:

American College of Surgeons, Committee on Trauma. Resources for the optimal care of the injured patient. 2022 rev Dec 2023. Chicago, IL: American College of Surgeons