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

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.

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.

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.

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.