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The presence of a pediatric emergency care coordinator was variably associated with pediatric quality-of-care measures across US EDs, according to research.

The presence of a pediatric emergency care coordinator (PECC) was variably associated with pediatric quality-of-care measures across US emergency departments (EDs), according to a study published online in JAMA Network Open.

“Significant policy efforts and implementation resources have aimed to increase the number of EDs that have a PECC, yet the specific impact of PECCs on pediatric quality and outcomes remains undefined,” wrote corresponding author Margaret E. Samuels-Kalow, MD, of Massachusetts General Hospital, and coauthors.

Analyzing the Association

To examine how PECCs influence ED performance for patients aged 18 years and younger, researchers evaluated seven key quality-of-care measures:

1. Stays exceeding one day for discharged patients;
2. Departures against medical advice or before completing treatment;
3. Death;
4. Return visits within 3 days;
5. Return visits resulting in admission within 3 days;
6. Chest radiography usage for asthma; and
7. Head computed tomography (CT) for head trauma.

The researchers used data from eight states, combining the 2019 National Emergency Department Inventory-USA, 2019 State Emergency Department Database and State Inpatient Database, 2020 Supplemental National Emergency Department Inventory PECC Survey, and the 2021 National Pediatric Readiness Project Survey. The analysis encompassed more than 4.6 million pediatric visits across 858 hospitals.

Hospitals were stratified by pediatric resources: highly pediatric-resourced facilities that admitted children and had pediatric intensive care units (PICUs); moderately pediatric-resourced hospitals that admitted pediatric patients but did not have PICUs; and non-pediatric-resourced hospitals that did not admit children. Notably, 88% of highly resourced pediatric hospitals, 35% of moderately resourced centers, and just 13% of non-resourced hospitals employed a PECC.

Inconsistent Impact

The researchers discovered that the association between PECC presence and improved performance on quality measures was not uniform.

In non-pediatric-resourced hospitals, a PECC correlated with reduced head CT utilization for trauma patients (adjusted odds ratio [AOR] 0.76), compared with an AOR of 0.85 in both highly and moderately resourced hospitals. Conversely, PECCs were linked to lower rates of chest radiography in asthma patients at highly and moderately resourced hospitals (AOR 0.77) but demonstrated no significant effect in non-pediatric-resourced hospitals (AOR 0.93).

“The presence of a PECC was variably associated with performance on imaging utilization measures, suggesting a potential influence of PECCs on clinical care processes,” researchers concluded. “Additional studies are needed to understand the role of PECCs in driving adherence to clinical care guidelines and improving quality and patient outcomes.”