P2.D065: Changes in Pediatric Readiness in Critical Access Hospitals 2013-2021: An Analysis of National Pediatric Readiness Project Data

Background: Critical Access Hospitals (CAH) are the emergency healthcare safety net for many rural children. Questions have been raised about CAH readiness for children. The National Pediatric Readiness Project (NPRP) assesses the infrastructure needed for emergency departments (ED) to manage critically ill and injured children. We compared CAH performance on the 2013 and 2021 NPRP surveys to assess changes in CAH ED readiness.

Methods: A retrospective cross-sectional cohort study of the NPRP assessments of all US EDs, administered from 1/2013-8/2013 and 5/2021-8/2021 was conducted. Hospitals that identified as CAH and participated in both assessments were included in the analysis. CAH characteristics were compared using McNemar tests of paired proportions.

Results: Of the 3,647 responses in 2021 and 4,149 responses in 2013, 748 respondents identified as CAH and completed both assessments. See table 1 for hospital characteristics. The median Weighted Pediatric Readiness Score (WPRS) did not change significantly over time. (65/100 in 2021 v 67/100 in 2013, p=0.073) Changes in pediatric readiness varied across domains between 2013 and 2021. In 2021, 43% of CAH had 100% of recommended pediatric equipment, compared to 23% in 2013 (p < 0.001). We found an increase in pediatric competency evaluations for physicians (52.8% in 2021, 18% in 2013; p< 0.001) and nurses (83% in 2021, 44% in 2013; p< 0.001). We also found improvement in pediatric specific policies and procedures in place, including: weighing children in kilograms only (66% v 47%; p< 0.001), reduced dose radiation for imaging (67% v 42%; p< 0.001) and mental health focused policies (57% v 29%; p< 0.001). The presence of pediatric emergency care coordinators (PECCs) decreased significantly between 2021 and 2013 (36% v 65%, p< 0.001). See table 2 for full details.

Conclusion: While overall WPRS did not change significantly, CAH EDs demonstrated significant improvement in several domains of pediatric readiness from 2013 to 2021. However, this improvement was uneven. Nearly double the number of hospitals carried 100% of necessary pediatric equipment in 2021.
That number still represented less than 50% of the participating CAH. The increased presence of policies related to weighing children in kilograms only, reduced dose radiation, and mental health may reflect a growing awareness of pediatric-specific needs.

The percentage of CAH having PECCs declined by nearly half between the two survey years. During the COVID pandemic, CAHs were impacted by staff turnover and increased prioritization of adult patients. The loss of PECCs among CAH may portend a lack of long-term sustainability of improvements in pediatric readiness. PECCs remain the leading driver of overall pediatric readiness. Efforts to strengthen and sustain the PECC workforce among CAH are needed. Studies evaluating the impact of pediatric readiness on patient-centered outcomes at CAH EDs may help to reinforce the importance of sustained pediatric readiness.