Lack of pediatric readiness in hospitals is ‘a national risk to children’

Most community hospitals aren’t equipped to properly care for children in their emergency departments.

Dr. Steve Narang, president of Inova Fairfax Medical Campus and the president of the Inova Pediatric Service Line, says it’s a serious problem that raises the risk of children dying.

“Less than 20% now of all ERs in the country meet the standards for pediatric readiness,” Narang says. “That's a national risk to children.”

Narang says there is “a crisis in the readiness of many community hospitals to take care of children.”

Nationwide, 17% of hospitals were found to have high pediatric readiness, according to a study published by JAMA Network Open.

Earlier this year, a group of medical societies released new standards for pediatric readiness in the emergency room. The Emergency Nurses Association, American Academy of Pediatrics, American College of Emergency Physicians and the American College of Surgeons put together the policy statement.

The groups recommend more training in caring for children in the emergency department. Hospitals are also urged to appoint a doctor and nurse as pediatric emergency care coordinators to promote better skills and knowledge among the staff. The statement also includes a pediatric readiness checklist.

If all hospitals bolstered their training and skills in treating children in emergency rooms, more than 2,100 children’s lives nationwide each year could be saved, the groups say.

Dustin Bass, president of the Emergency Nurses Association, said improving readiness can build confidence in emergency teams.

“Every minute counts for parents and caregivers seeking emergency care when their child suffers a sudden illness or injury,” Bass said in a statement accompanying the new readiness standards.

Narang, who is a pediatrician, says hospitals need to take a closer look at their ability to treat kids in the emergency department. But he says it goes beyond having the right equipment in the hospital.

“Readiness is a culture,” he says. “It's a process, it's a system, and the biggest barrier is not knowledge or standards … It's about priorities and execution.”

• Read more: Why kids wait months for specialty care

‘Honest assessment’

The Inova health system in northern Virginia has invested heavily in its pediatric capabilities.

Inova operates a 226-bed children’s hospital, and recently completed a redesign of a 21,500-square-foot pediatric emergency room. The system has also hired over 100 specialists, which Narang says is “very hard to do pediatrics.”

But Narang says he gained an understanding of the problem with pediatric readiness earlier in his career, when he worked in a community hospital in rural Louisiana.

Many community hospitals don’t have emergency room staff with deep training in pediatric care. Typically, emergency physicians have only a few months of work in pediatrics, Narang says.

Plus, community hospitals usually don’t treat many children in the emergency room, so they aren’t getting regular work in caring for kids. As a result, pediatric readiness diminishes.

“When you have low volume, it's very hard to find the structure and the leaders to execute,” Narang says.

Not enough doctors are pursuing careers in pediatric emergency medicine, which requires years of additional training, leaders of children’s hospitals say. Some of those who are struggling with high debts from medical school opt for different specialties where they can begin earning more on an earlier timetable.

Hospitals have also had to take a harder look at pediatric services in recent years. Some hospitals have closed pediatric inpatient beds due to financial pressures.

From 2008 to 2022, U.S. hospitals closed nearly 30% of pediatric inpatient units, according to a study published by Jama Pediatrics.

“Many of these health systems have had to make decisions that are tough,” Narang says.

Still, hospitals need to evaluate their emergency room capabilities when it comes to treating children, he says. Narang says hospitals should do “an internal honest assessment of what the gap is.”

“If I were a leader of a community hospital, and even without a formal designation as part of a larger health system, the first thing I would do is identify that as a real risk,” Narang says. “And I would say there's a risk for the entire fabric of the community. Nobody wants to be in the headline for that one child who had a potential morbidity or potential death related to being unprepared, the reputational risk of that community, but more importantly, just the moral obligation of being a leader of a hospital.”

Pointing to the pediatric readiness standards, Narang says identifying a physician and nurse to take leadership in training for emergency care for kids can make a substantial difference.

Hospitals leaders should make sure that “these two leaders' voices are heard at the highest level of that institution,” Narang says.

• Read more: Hospitals must recognize burnout in emergency rooms

‘There is an ROI’

Health systems can also find investing more money in pediatric emergency care can pay dividends, along with gaining more community recognition for investing in children.

“There is an ROI,” Narang says. “More people will choose to be cared for, and not go to the outside hospital.”

Inova has found that investing in pediatric care has driven more business.

“The pediatric service line is one of the fastest growing market shares within Innova, but it's been a driver for our other service lines, because families really pick what systems they trust and do they trust to take my child there,” Narang says.

“Think about what you can do in your own community,” he adds. “And it may not be as expensive as you think, and the ROI may be much broader than you believe.”

Patients are getting treated more quickly, and fewer patients are leaving the emergency department without being seen, he says.

“It de-clogs our adult emergency rooms,” Narang says. “We've seen significant improvement of flow and throughput in our emergency rooms, because our children are now seen in separate areas.”

‘More cooperation and less competition’

Narang says community hospitals that aren’t part of larger health systems should consider forming relationships with other providers who can boost their capabilities.

“At the end of the day, especially with children's health care, there should be more cooperation and less competition,” Narang says.

Hospitals and health systems that are smaller and have less money to spend can still take steps to improve their readiness for pediatric emergencies. It can start with CEOs and top leaders acknowledging the problem.

Narang says forming alliances with other providers, such as establishing relationships for virtual consultations, can help hospitals with limited resources.

“The reality is, the difference between a ready ED and an unprepared one can be life-saving,” Narang says. “So it's preparation, and preparation means identifying those two leaders, picking up the national preparedness guidelines, speaking about the gaps openly, and then having a roadmap of how to close it internally and then externally, with partnerships and then continuous improvement.”

Narang says pediatric readiness in emergency rooms must improve to protect children. Hospital leaders should recognize it as a serious problem, but not one that is insurmountable.

“It is one of health care's most solvable problems,” Narang says. “It's actually solvable. The evidence is strong, the investment is modest, and the impact is profound.”