A national coalition of medical associations has issued updated recommendations for ensuring that hospital EDs are fully prepared to meet the emergency healthcare needs of children.
Pediatric Readiness in the Emergency Department was developed by the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP), the Emergency Nurses Association (ENA) and the American College of Surgeons (ACS). The new policy statement is an update of recommendations previously revised in 2009 and 2018.
Trauma System News recently spoke with Aaron Jensen, MD, MEd, MS, FACS, FAAP, a pediatric and trauma surgeon at the University of California San Francisco and a co-author of the policy statement.
Dr. Jensen talked about six ways the new statement provides emergency and trauma care leaders with expanded guidance on pediatric readiness.
Increased focus on using pediatric-specific guidelines
The updated recommendations include a greater emphasis on the need for pediatric-specific clinical practice guidelines and decision support tools.
“There continues to be a lot of variability as to how pediatric patients are treated in the emergency department, and it is often inconsistent with best practices,” Dr. Jensen said.
“If you look specifically at trauma, one of the new recommendations is that all EDs have a pediatric-specific massive transfusion protocol, a weight-based protocol that’s just for kids,” he said. “Because if you apply an adult MTP to a two-year-old 10 kg kid, they’re going to get over-transfused with red cells and under-transfused with plasma.”
Emphasis on tracking pediatric quality measures
Approximately 80% of adult EDs see less than 10 pediatric patients per day, which makes it difficult to benchmark outcomes.
To help EDs bridge that gap, the updated guidelines reference the new National Pediatric Readiness Quality Initiative (NPRQI), which focuses on process measures.
“The NPRQI Collaborative is a free benchmarking program that EDs can sign up for that uses evidence-based quality metrics,” Dr. Jensen said. “A lot of the metrics are designed around processes of care, like who should get a head CT when they hit their head and who should get intubated when they have TBI. These processes occur frequently and they are things that we can impact.”
According to Dr. Jensen, any hospital can take part in the NPRQI Collaborative.
“You can put in 10 patients, you can put in 100 patients, you can put in as many as you want,” he said. “It is an infrastructure now available for EDs to do case-based quality improvement with benchmarking.”
Emphasis on multidisciplinary review of all pediatric events
The updated Pediatric Readiness in the Emergency Department statement encourages ED leaders to conduct a multidisciplinary review of all pediatric mortalities and other adverse events. The goal is to identify ways to improve pediatric emergency care.
“EDs should be looking at those cases to identify possible opportunities for improvement,” Dr. Jensen said. “There may not be any opportunities for improvement, but you’ll never know unless you look at the cases.”
New recommendations around pediatric mental health
The updated guidelines also encourage EDs to develop evidence-based screening and treatment policies/protocols for children with mental or behavioral health emergencies.
“This is a growing problem in our country,” Dr. Jensen said. “Kids are having mental health crises and can’t get care through mental health providers, so they’re showing up in EDs.”
He said adult EDs must have processes in place for responding to these emergencies.
“The recommendation is that every ED should have a process for recognizing mental health emergencies and a process to get those kids the help they need, whether it be through partnership with a regional pediatric center or mental health providers,” he said.
Importance of pediatric equipment
The new guidelines also reinforce the importance of maintaining pediatric-specific equipment, including medication dosage tools.
Dr. Jensen noted that pediatric equipment costs are low compared to most hospital expenditures.
“Even in the lowest-volume centers, the estimated cost is $40 to $50 per patient in order to have optimal readiness to care for kids,” he said. “That’s a really trivial cost compared to the many other things we spend a lot of money on in healthcare.”
Broader expectations for pediatric considerations in disaster preparedness
“Many hospital disaster plans, particularly at general hospitals, don’t specifically address the needs of children,” Dr. Jensen said. “But those hospitals are going to have to take care of children during a disaster because the children’s hospitals are going to be overwhelmed.”
One major issue in pediatric-specific disaster planning is family separation.
“Families are going to get split up during a disaster, whether it’s intentional or unintentional, so you have to think about that,” he said. “How do we support kids who have been separated from their families? How do we triage kids? Is it more important to keep kids with their families, or is it more important to send kids to the children’s hospital?
New peds readiness assessment now open
The 2026 National Pediatric Readiness Project (NPRP) Assessment for Emergency Departments opened in March.
According to Dr. Jensen, pediatric readiness as measured by the NPRP assessment improved significantly between 2013 and 2018. However, improvement stalled during the COVID-19 pandemic.
“This is mostly because a lot of people who were occupying the pediatric emergency care coordinator (PECC) role either were laid off or left medicine or were pushed into staffing to take care of the crises,” Dr. Jensen said. “So the new 2026 assessment is the first time post-pandemic that we will be assessing pediatric readiness while we’re in ‘normal’ operating conditions for hospitals.”
