Pediatric Readiness in Critical Access Hospital Emergency Departments

J Rural Health. 2019 Sep;35(4):480-489. doi: 10.1111/jrh.12317. Epub 2018 Jul 30.


Purpose: Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care.

Methods: The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS). A WPRS of 100 indicates that the ED meets essential guidelines for pediatric readiness. Using descriptive statistics, we also compared low (fewer than 5 children a day) and medium patient volume (5-14 children a day) EDs in 6 core areas of readiness.

Findings: Eighty-six percent (1,140) of CAHs were linked to the NPRP. In the study, 80% were low and 20% medium volume. The median WPRS was 59.0 for low and 67.3 for medium volume. While some differences were found by patient volume, overall 63% of CAHs had a pediatric emergency care coordinator, 34% had a pediatric patient care review process, 62% had interfacility transfer guidelines, and 45% weighed children only in kilograms. CAHs participating in a facility recognition program had significantly higher median WPRS scores (84.3) compared to those not participating (59.5).

Conclusion: CAHs have challenges in being ready to care for children in the areas of pediatric emergency care coordinators, policies, procedures, and patient safety. Minimal cost interventions are available to increase the readiness of CAHs to care for children.

Keywords: critical access hospital; emergency departments; emergency medical care; pediatric care coordinator; pediatric readiness.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child
  • Clinical Competence / standards
  • Clinical Competence / statistics & numerical data
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / standards*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Male
  • Pediatrics / standards*
  • Pediatrics / statistics & numerical data
  • Quality Improvement
  • Safety-net Providers / organization & administration
  • Safety-net Providers / statistics & numerical data
  • Surveys and Questionnaires
  • United States