Sanyukta Desai

Over 80% of all pediatric emergency visits occur in non-pediatric emergency departments (EDs). Continuous quality improvement (QI) is linked to higher pediatric readiness and improved patient outcomes, and, consequently, can lead to a 76% decreased mortality risk for critically ill and injured children. However, fewer than one third of EDs use quality indicators to evaluate and improve pediatric care delivery. Major barriers to QI in non-pediatric EDs include the absence of performance standards; challenges with standardized data collection, analysis, and benchmarking; and limited institutional resources to enhance pediatric emergency care. The authors describe the National Pediatric Readiness Quality Initiative (NPRQI), a free and secure platform that provides ED-based health care teams with real-time, crucial insights into the quality of pediatric emergency care delivery to empower providers to engage in pediatric QI. The NPRQI overcomes the aforementioned barriers to QI by providing (1) the first nationally vetted pediatric quality measures that apply to all types of EDs, including resource-restricted, low-volume EDs; (2) standardized data collection, performance visualization, and benchmarking for participating EDs; and (3) a free, secure web-based direct-to-provider interface for rapid interpretation and action by health care teams. Since its launch in 2023, the NPRQI has engaged more than 100 diverse EDs across 26 states. The NPRQI seeks to transform pediatric emergency care by shortening the time to adoption of and adherence to evidence-derived clinical processes through data transparency and benchmarking. Furthermore, by capturing pediatric care delivery nationally across all types of EDs, the NPRQI is poised to establish the first set of national standards for pediatric emergency care following the model of standards established for stroke and cardiac centers.

Background: Radiologic imaging is routinely performed to aid in diagnosis for hospitalized children. Identifying and reducing variability in imaging practices can improve care while reducing harms and costs.Objectives: To identify common inpatient pediatric conditions with high prevalence of imaging and variation in imaging practices and imaging‐related costs across hospitals.Methods: We conducted a cross‐sectional study of children 0–18 years old admitted to 50 children's hospitals in the Pediatric Health Information Systems database between 2017 and 2019. We excluded patients with complex chronic conditions, pregnancy, newborn, or neonatal intensive care charges, and those who died or who were discharged to hospice or rehabilitation facilities. Conditions with at least 2500 discharges and in which ≥30% of patients received imaging were included. Outcomes included imaging frequency, standardized imaging‐related costs (including all modalities across all encounters), and hospital‐level variation in imaging costs using the intraclass correlation coefficient (ICC).Results: Of the 56 included conditions, imaging was most frequently conducted in patients with pectus excavatum (97.8%), scoliosis (96.2%), and intestinal obstruction (96%). Fracture ($21.4 million), trauma ($15.7 million), and appendicitis ($8.6 million) had the highest total imaging‐related costs. Conditions with the highest geometric mean standardized imaging costs were nervous system disorders ($507), osteomyelitis ($494), vesicoureteral reflux/hydronephrosis ($468). Scoliosis (ICC = 0.49) and preseptal cellulitis (ICC = 0.48) had the highest variation in imaging‐related costs.Conclusion: To reduce imaging overuse in hospitalized children, conditions with frequent imaging, high imaging‐related costs, and high hospital‐level variation in imaging practices should serve as priorities for future evidence generation, guideline development, and/or improvement initiatives.