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Many ERs still aren't well prepared to treat kids, study finds

One of the most important things an ED needs is nurse or doctor who's been designated a "pediatric champion," or pediatric emergency care coordinator.

A new national report shows how prepared (or unprepared) emergency departments are to treat kids - and how the COVID-19 pandemic impacted that readiness.

Most emergency departments are primarily designed to treat adults, and the majority of EDs in the US treat fewer than 10 kids a day. But kids need different kinds of care than adults, and being prepared pays off: thesurvival ratesfor critically-ill kids are four-times higher at emergency departments that have high “pediatric readiness” ratings (meaning the National Pediatric Readiness Project scores them above an 87 or higher, on a scale of 1 to 100.)

And a recent study of nearly 1,000 emergency departments found more than 1,400 children's deaths could have been prevented over a six-year period, if every department had high levels of pediatric readiness.

Yet until now, the median score for EDs has been the equivalent of a D.

On Friday, the National Pediatric Readiness Projectpublished new data from a 2021 assessment of some 3,500 EDs. The good news: emergency departments are making some real improvements in most areas, like patient safety, equipment and supplies, and staff training. For instance, 73% of EDs now have a pediatric mental health care policy in place, compared to just 44% previously.

The bad news: there was a nearly 14% drop in EDs with nurses or doctors designated as the Pediatric Emergency Care Coordinator (PECC.) Sometimes called the “pediatric champion,” the PECC “is one of—if not the—strongest driver of improved quality of emergency care for children,” according to the Emergency Medical Services for Children Innovation and Improvement Center.

“PECCs are a key driver of pediatric readiness,” Dr. Hilary Hewes, one of the study’s co-authors and a pediatric emergency medicine physician at University of Utah Health, said in a statement Friday. “Unfortunately, the pandemic worsened widespread workforce shortages. Many EDs didn’t have resources to sustain the PECC role.”

Because the PECC role is weighted so heavily, the adjusted median score for EDs actually fell slightly, to 69.5.

But Dr. Marianne Gausche-Hill, a study co-author and the co-director of the National Pediatric Readiness Project, said there was reason for optimism. “The improvement in five of six categories despite these circumstances is most notable, reflecting high engagement of providers over the last eight years,” she said in a statement.

Kate Wells is a Peabody Award-winning journalist currently covering public health. She was a 2023 Pulitzer Prize finalist for her abortion coverage.