A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals
Related Experiment Video
Updated: Feb 26, 2026
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Travis Whitfill1, Marcie Gawel, Marc Auerbach
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
Insights
A simulation-based quality improvement program significantly enhanced pediatric emergency readiness scores in Connecticut hospitals. This initiative improved overall scores and specific domains like care coordination and equipment availability.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Quality Improvement
Background:
- The National Pediatric Readiness Project (PRS) revealed suboptimal pediatric readiness in US emergency departments (EDs) with an average score of 69/100.
- Key areas of weakness included coordination of care, staffing, quality improvement, patient safety, policies, and equipment availability.
Purpose of the Study:
- To assess and improve pediatric emergency readiness scores in Connecticut hospitals.
- To compare National Pediatric Readiness Project (PRS) scores before and after an in situ simulation-based intervention.
Main Methods:
- In situ simulations evaluated interprofessional teams' resuscitative care for simulated pediatric emergencies (sepsis, seizure, cardiac arrest).
- Assessments included adherence to guidelines and teamwork, followed by a detailed gap analysis report.
- A collaborative quality improvement program with regional children's hospital support was implemented.
Main Results:
- Twelve Connecticut EDs participated, with PRS scores measured pre- and post-intervention (average 21 months apart).
- Overall PRS scores significantly improved by 12.9% (from 64 to 77, P=0.022).
- Substantial improvements were noted in coordination of care (50%), quality improvement (79%), and equipment availability (7%).
Conclusions:
- Participation in a simulation-based quality improvement collaborative is associated with enhanced pediatric emergency readiness.
- Targeted interventions can effectively improve critical domains of pediatric care in EDs.
Background:
The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals.
Objective:
The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals.
Methods:
We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation.
Results:
Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12.9% from the first assessment (mean ± SEM = 64 ± 4.4) to the second assessment (77 ± 4.0, P = 0.022). The PRS score domains also showed improvements in coordination of pediatric patient care (median improvement, 50%), quality improvement activities (median improvement, 79%), patient safety initiatives (mean improvement, 7%), policies and procedures (mean improvement, 17%), and availability of pediatric equipment (mean improvement, 7%).
Conclusions:
Participation in a simulation-based quality improvement collaborative was associated with improvements in pediatric readiness.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:30Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...