A multicomponent intervention for pediatric readiness in general emergency departments: a single-blind, matched-pair...

Area of Science:

• Emergency Medicine
• Pediatric Care
• Healthcare Quality Improvement

Background:

• Pediatric readiness is crucial for improving outcomes and reducing mortality in children treated in emergency departments (EDs).
• Baseline assessments revealed significant gaps in pediatric readiness, particularly in coordination, staffing, training, and quality improvement domains.
• Targeted interventions are necessary to address these identified deficiencies in general EDs.

Purpose of the Study:

• To evaluate the effectiveness of a multi-component, context-informed intervention designed to enhance pediatric readiness in general EDs.
• To assess the impact of the intervention on the weighted pediatric readiness score (WPRS) in participating sites.
• To identify factors influencing changes in pediatric readiness following the intervention.

Main Methods:

• A single-blinded, matched-pair randomized controlled trial was conducted across 17 general EDs.
• Sites were randomized to receive either a multi-component intervention or a control (report only).
• Pediatric readiness was measured using the Canadian adaptation of the National Pediatric Readiness Survey, with WPRS as the primary outcome, analyzed using Welch's t tests and mixed-effects linear regression with Bayesian analyses.

Main Results:

• Sixteen EDs completed the study; the intervention group showed a mean decrease of -4.8 in WPRS, while the control group had a mean increase of +2.4.
• No statistically significant difference in WPRS change was observed between the intervention and control groups (p=0.4).
• Performance remained highest in patient safety and equipment/supplies, with quality improvement consistently being the lowest-scoring domain.

Conclusions:

• A low-intensity, multi-component intervention did not lead to significant improvements in pediatric readiness across general EDs.
• The substantial variation in site-level changes suggests that context-responsive and more intensive strategies may be required to effectively improve pediatric readiness.
• Future interventions should consider tailored approaches to address specific site needs and enhance care for pediatric patients in emergency settings.