Research In Practice Blog
When a child visits the emergency department (ED), families expect quick, effective, and compassionate care. Achievable Benchmarks of Care (ABCs) are realistic performance goals based on what top-performing emergency departments and clinicians are already accomplishing. These benchmarks assist hospitals in measuring their performance, identifying areas for improvement, and striving toward high-quality care that has already been demonstrated to be attainable.
This research identified Achievable Benchmarks of Care that aim to monitor, compare, and encourage improvements that enhance the quality of pediatric care in emergency departments. The research team included Clinical Futures experts Joseph J. Zorc, MD, MSCE, and Robert W. Grundmeier, MD, and the study was published in JAMA Network Open with the goal of establishing practical benchmarks for care in pediatric emergency departments throughout the United States.
Methods
Researchers analyzed more than 5.3 million pediatric emergency department visits from 12 emergency departments participating in the Pediatric Emergency Care Applied Research Network (PECARN) between 2017 and 2024. These included nine large pediatric emergency departments at children's hospitals (known as quaternary centers) and three affiliated community emergency departments. ABCs were calculated for the registry as a whole and for individual sites separately. Individual sites and providers received regular feedback on the ABCs through e-mailed report cards throughout the period. The median patient age was 5.1 years and 52.6% were male.
The study evaluated benchmarks across several areas of emergency care, including:
- Initial assessment, such as documenting a child's weight and vital signs.
- Timeliness and patient flow, including how quickly a clinician sees a child and how long patients stay in the emergency department.
- Quality and safety measures, such as return visits requiring admission.
- Condition-specific care, including treatment of asthma, infections, and pain from fractures.
Study Results and Findings
The team calculated a wide range of pediatric-relevant achievable best-practice benchmarks across settings and time:
- ABCs for initial care about the documentation of weight, heart rate, and respiratory rate consistently met or exceeded 96%, suggesting that most departments reliably completed these essential components of care.
- When researchers examined patient flow, they found notable differences in how quickly a clinician evaluated children, with time-to-clinician metrics increased with de triage acuity (measured by emergency severity index). The site-level ABCs for time-to-clinician were 19 (range, 16-40) minutes for quaternary EDs and 22 (21-26) minutes for affiliate sites.
- Quality safety measures varied by site but showed uniformly low levels of concerns. Return visits with admission ranged from <0.1% to 0.6%, and overall ABC for antibiotic use for viral illnesses was 0.2%, with minimal variability by site or care setting.
Researchers have identified specific areas for improvement in condition-specific care, particularly in pain management, asthma care, and emergency department wait times, which showed significant variation. The overall percentage of appropriate use of corticosteroids during encounters for patients with asthma exacerbations was 97.8%. Additionally, the documentation rate for pain scores in cases of long bone fractures across the network was 99.0%. However, among visits where patients reported moderate or severe pain, only 80.5% experienced a reduction of 2 points or more in their pain within 90 minutes. The PECARN Registry group is currently revisiting the current ABCs and choosing new ones based on updated metrics recommended to assess quality of care and an increased focus on outcomes.
Clinical Implications
The quality of healthcare can vary widely between hospitals. Without clear standards, it is challenging to determine if care is effectively addressing patients’ needs. The study revealed considerable differences in areas such as pain management, asthma care, vital sign documentation, and the timeliness of care. This variation suggests opportunities for hospitals to standardize care processes and improve consistency across providers and sites.
Achievable Benchmarks of Care help by defining top-performing standards based on real-world data, giving hospitals targets to aim for and highlighting gaps in care delivery. The inclusion of regular feedback and emailed report cards creates a feedback loop that allows for continuous improvement. This gives emergency departments practical evidence-based benchmarks that can guide improvement efforts. By aiming to achieve similar benchmarks of the top-performing pediatric emergency departments, hospitals nationwide can evaluate and strengthen their preparedness to care for children in emergency settings.
Clinical Futures author(s): Joseph J. Zorc, MD, MSCE; Robert W. Grundmeier, MD