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A multicomponent intervention for pediatric readiness in general emergency departments: a single-blind, matched-pair
Leah K Crockett1,2, Motunrayo Ajayi1, Lisa Knisley1,3
1The Children's Hospital Research Institute of Manitoba, John Buhler Research Centre, Winnipeg, MB, Canada.
Insights
A multi-component intervention did not significantly improve pediatric readiness in general emergency departments. Further research into more intensive, context-specific strategies is needed to enhance care for children.
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.
Objectives:
Pediatric readiness, measured using the weighted pediatric readiness score (WPRS; 0-100), is associated with improved outcomes and lower mortality. A baseline assessment identified gaps across domains, with the lowest scores in coordination, staffing and training, and quality improvement, highlighting the need for targeted intervention. We evaluated the effectiveness of a multi-component, context-informed intervention on improving pediatric readiness in general EDs.
Methods:
We conducted a single-blinded, matched pair randomized controlled trial in 17 general EDs (October 2022-May 2025). Sites were paired based on baseline WPRS, annual general ED volume, and distance from the provincial tertiary pediatric center and then randomized to a multi-component intervention or control. The intervention included a customized readiness report with discussion, pediatric resource toolkits, educational outreach, and ongoing support; control sites received the report only. Pediatric readiness was reassessed beginning six-month post-intervention using the Canadian adaptation of the National Pediatric Readiness Survey, from which WPRS is derived. The primary outcome was change in overall WPRS compared using Welch's t tests. Mixed-effects linear regression, with Bayesian analyses was conducted to strengthen confidence in the estimated intervention effects.
Results:
Sixteen general EDs (8 intervention, 8 control) completed follow-up. Median (IQR) post-intervention WPRS was 44.2 (14.7) for intervention sites and 53.9 (17.6) for control sites. Mean (SD) change in WPRS was - 1.2 (15.1) overall (intervention - 4.8 (16.7); control + 2.4 (13.4); p = 0.4). Post-intervention WPRS ranged from 38.2 to 79.3. Three sites achieved clinically meaningful improvement (> 10 points), nine remained stable, and four declined. No statistically significant intervention effects or covariate associations were identified. Performance was highest in the domains of patient safety and equipment and supplies, while quality improvement remained consistently lowest.
Conclusion:
A low-intensity multi-component intervention showed varied change in mean WPRS between the randomized sites. Substantial site-level variation suggests that context-responsive and more intensive strategies may be required.