Protecting Children in the Emergency Department: The National Pediatric Readiness Project Is Ready for Launch

by | Apr 12, 2021

A 10-year-old girl sustains a head injury in a playground accident. Parents are panicked over respiratory distress in their infant daughter. A 5-year old boy is suffering from abdominal pain due to suspected accidental poisoning. These are among the most common reasons for a frenzied visit to a community hospital emergency department (ED).[1]

Pediatric ED visits make up nearly one in every five of all ED visits.[2] Studies show that 17 percent of all children in the U.S. sought emergency care at least once.[3] Every day, 80,000 children will seek care in a U.S. ED. Almost three quarters of these visits will be in a community hospital without a pediatric specialty ED.[4]

The most concerning aspect behind these statistics is that most general EDs and EMS agencies fail to require specialized pediatric training for clinical staff, and most don’t have a full complement of pediatric equipment, medications, and supplies to treat children when they come to an ED. A report from the institute of Medicine, Growing Pains, revealed a serious lack of research on best practices, clinical outcomes, and patient safety in most general EDs and EMS agencies when it comes to handling pediatric emergencies.[5]

An initiative set to launch on May 1, 2021 aims to remedy these shortcomings. The Emergency Medical Services for Children Innovation and Improvement Center (EIIC), supported by the Emergency Medical Services for Children (EMSC) Program, American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), and Emergency Nurses Association (ENA) is promoting the National Pediatric Readiness Project (NPRP) ​assessment. The NPRP is an ongoing quality improvement (QI) program designed to promote optimal care of children in all U.S. and territory EDs.  The initial NPRP assessment was administered in 2013 and the second nationwide assessment is set to launch on May 1st.

The three-fold goal of the National Pediatric Readiness Project is to:

  • Establish a composite baseline of the nation’s capacity to provide care to children in the ED
  • Create a foundation for EDs to engage in ongoing QI processes that include implementing the “Guidelines for the Care of Children in the Emergency Department”
  • Establish a benchmark that measures an ED’s improvement over time.

Why National Pediatric Readiness Project?

Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill or injured are brought to the nearest community hospital EDs, regardless of whether or not it is able to properly treat a child in an emergency. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) along with capable, trained staff to provide effective emergency care for children.

Lack of a common standard of care for children in the ED puts our most vulnerable patients – our children – at risk at a time when immediate, expert care is needed most. Adoption of pediatric ED guidelines across the country will ensure that children receive optimal care regardless of which ED they visit.

National Pediatric Readiness Project Rollout

Phase One of the National Pediatric Readiness Project involved a national electronic assessment sent to 5,000 EDs across the U.S. and U.S. territories in 2013. This initial assessment was completed by 82 percent of the recipients. The overall readiness score of those returning the assessment was 69 (out of 100), highlighting the fact that there is much work still to be done.
Phase Two involves analyzing and sharing insights from the data and creating additional resources, tools, and partnerships to engage the healthcare community to influence change. In addition, this phase includes administering ongoing nationwide pediatric readiness assessments to gauge improvement in this domain.

Both the 2013 and the upcoming 2021 assessment consisted of 60 questions that addressed areas of:

  • Administration and Coordination for the Care of Children in the ED
  • Physicians, Nurses, and Other ED Staff
  • Quality/Process Improvement in the ED
  • Pediatric Patient and Medication Safety
  • Policies, Procedures, and Protocols
  • Equipment, Supplies, and Medications

The National Pediatric Readiness Project has developed a toolkit – a comprehensive and dynamic set of resources – coordinated by the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) with the support and contribution of numerous national experts. This toolkit is available as a free open-access resource intended for use by all providers (e.g. technicians, nurses, physicians, EMS providers, and ancillary staff) across the spectrum of pediatric emergency care to help facilitate delivery of high quality care to all children who visit an ED.

To help EDs across the country with the National Pediatric Readiness Project and upcoming assessment, and to help fulfill our mission of protecting children and caregivers from the dangers of medication errors, we have developed a special version of SafeDose, called “Copper”, to address the specific National Pediatric Readiness Project medication requirements. This special program can help ensure safe emergency medication dosing to pediatric patients in your ED for a pint-sized fraction of our standard SafeDose content offering. Email us for more information on SafeDose Copper subscriptions.

There can be no greater undertaking than protecting our children in their greatest time of need – when they are sick or injured. The National Pediatric Readiness Project brings an enormous cohort of healthcare organizations together with a common goal of ensuring that EDs all across the country are offering the best possible care for our important pediatric patients.


[1] Overview of Pediatric Emergency Department Visits, 2015, Healthcare Cost and Utilization Project, Statistical Brief, August 2018.

[2] Trends in Emergency Department Visits, 2006–2014, by BJ Moore, C. Stocks, PL Owens. HCUP Statistical Brief #227. September 2017. Agency for Healthcare Research and Quality, Rockville, MD.

[3] Emergency Department Visits Within the Past 12 Months Among Children Under Age 18, by Selected Characteristics: United States, Selected Years 1997–2015. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-Term Trends in Health. Table 73. Centers for Disease Control and Prevention, National Center for Health Statistics.

[4] Ensuring Pediatric Readiness for All Emergency Departments, National Pediatric Readiness Project white paper, July 2017

[5] Ibid