PECC Status and Pediatric Readiness in General Emergency Departments: Trends and Hospital Correlates

Pediatric Readiness in U.S. emergency departments (EDs) is associated with improved outcomes for critically-ill children. Most children seek emergency care in general EDs. Pediatric Emergency Care Coordinators (PECCs) have been shown to improve readiness; however, their presence declined following the pandemic. We examined the association between PECC status over time with hospital ED characteristics and Pediatric Readiness in general EDs.

We conducted a retrospective cohort study using data from the 2013 and 2021 National Pediatric Readiness Project (NPRP) assessments. General EDs completing both assessments were categorized by PECC status as retained, gained, lost, or never had a PECC. The primary outcome was adjusted Weighted Pediatric Readiness Score (aWPRS), calculated by removing PECC-associated points and normalizing to 100. Associations between PECC status and aWPRS, including domain scores, were evaluated using multivariable logistic regression and nonparametric testing.

Among 2,533 general EDs, 29.3% retained a PECC, 12.9% gained a PECC, 33.9% lost a PECC, and 23.9% never had a PECC. Lower pediatric visit volume was associated with PECC loss (p<.001). EDs that gained or retained a PECC were more likely to require EM/PEM board certification and pediatric competency evaluations. EDs that lost or never had a PECC demonstrated significantly lower overall aWPRS and lower scores across all readiness domains compared with EDs that gained a PECC.

In general EDs nationwide, absence or loss of a PECC was associated with significantly lower Pediatric Readiness. These findings underscore the critical role of PECCs in sustaining pediatric emergency preparedness and support prioritizing institutional investment for this role.