The hospital costs of high emergency department pediatric readiness

Remick, Katherine E.; Gausche‐Hill, Marianne; Lin, Amber; Goldhaber‐Fiebert, Jeremy D.; Lang, Benjamin; Foster, Ashley; Burns, Beech; Jenkins, Peter C.; Hewes, Hilary A.; Kuppermann, Nathan; McConnell, K. John; Marin, Jennifer; Weyant, Christopher; Ford, Rachel; Babcock, Sean R.; Newgard, Craig D.; ,

doi:10.1002/emp2.13179

Cited by 5 publications

(1 citation statement)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 Although the association between individual components of readiness and survival has differed across studies, 35,36 the first step to improving ED pediatric readiness is adding PECCs, who are integral to all aspects of ED readiness 37 and are typically existing ED nurses and physicians. 38,39 There are publicly available checklists and toolkits designed to assist EDs in increasing their level of pediatric readiness. 40 ED pediatric readiness can play a role in reversing the current trend of increasing mortality among children in the US (especially from injury).…”

Section: Jama Network Open | Emergency Medicinementioning

confidence: 99%

Changes in Emergency Department Pediatric Readiness and Mortality

Newgard,

Rakshe,

Salvi

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceHigh emergency department (ED) pediatric readiness is associated with improved survival, but the impact of changes to ED readiness is unknown.ObjectiveTo evaluate the association of changes in ED pediatric readiness at US trauma centers between 2013 and 2021 with pediatric mortality.Design, Setting, and ParticipantsThis retrospective cohort study was performed from January 1, 2012, through December 31, 2021, at EDs of trauma centers in 48 states and the District of Columbia. Participants included injured children younger than 18 years with admission or injury-related death at a participating trauma center, including transfers to other trauma centers. Data analysis was performed from May 2023 to January 2024.ExposureChange in ED pediatric readiness, measured using the weighted Pediatric Readiness Score (wPRS, range 0-100, with higher scores denoting greater readiness) from national assessments in 2013 and 2021. Change groups included high-high (wPRS ≥93 on both assessments), low-high (wPRS &lt;93 in 2013 and wPRS ≥93 in 2021), high-low (wPRS ≥93 in 2013 and wPRS &lt;93 in 2021), and low-low (wPRS &lt;93 on both assessments).Main Outcomes and MeasuresThe primary outcome was lives saved vs lost, according to ED and in-hospital mortality. The risk-adjusted association between changes in ED readiness and mortality was evaluated using a hierarchical, mixed-effects logistic regression model based on a standardized risk-adjustment model for trauma, with a random slope–random intercept to account for clustering by the initial ED.ResultsThe primary sample included 467 932 children (300 024 boys [64.1%]; median [IQR] age, 10 [4 to 15] years; median [IQR] Injury Severity Score, 4 [4 to 15]) at 417 trauma centers. Observed mortality by ED readiness change group was 3838 deaths of 144 136 children (2.7%) in the low-low ED group, 1804 deaths of 103 767 children (1.7%) in the high-low ED group, 1288 deaths of 64 544 children (2.0%) in the low-high ED group, and 2614 deaths of 155 485 children (1.7%) in the high-high ED group. After risk adjustment, high-readiness EDs (persistent or change to) had 643 additional lives saved (95% CI, −328 to 1599 additional lives saved). Low-readiness EDs (persistent or change to) had 729 additional preventable deaths (95% CI, −373 to 1831 preventable deaths). Secondary analysis suggested that a threshold of wPRS 90 or higher may optimize the number of lives saved. Among 716 trauma centers that took both assessments, the median (IQR) wPRS decreased from 81 (63 to 94) in 2013 to 77 (64 to 93) in 2021 because of reductions in care coordination and quality improvement.Conclusions and RelevanceAlthough the findings of this study of injured children in US trauma centers were not statistically significant, they suggest that trauma centers should increase their level of ED pediatric readiness to reduce mortality and increase the number of pediatric lives saved after injury.

show abstract

Section: Jama Network Open | Emergency Medicinementioning

confidence: 99%

Changes in Emergency Department Pediatric Readiness and Mortality

Newgard,

Rakshe,

Salvi

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

Saving Children’s Lives Through Universal Pediatric Readiness Is a Wise Investment

Burke,

Beaute,

Michelson

2024

JAMA Netw Open

View full text Add to dashboard Cite

State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved

Newgard,

Lin,

Goldhaber-Fiebert

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceHigh emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown.ObjectiveTo estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year.Design, Setting, and ParticipantsThis cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024.ExposureEDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness).Main Outcomes and MeasuresAnnual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness.ResultsA total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year.Conclusions and RelevanceIn this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children’s lives each year.

show abstract

The hospital costs of high emergency department pediatric readiness

Cited by 5 publications

References 14 publications

Changes in Emergency Department Pediatric Readiness and Mortality

Changes in Emergency Department Pediatric Readiness and Mortality

Saving Children’s Lives Through Universal Pediatric Readiness Is a Wise Investment

State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved

Contact Info

Product

Resources

About