The National Pediatric Readiness Project is a national multi--phase quality improvement initiative to ensure all U.S. emergency departments have the essential guidelines and resources in place to provide effective emergency care to children 1 . The support for this project is provided by the EMS for Children Program, the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association. In January 2013, the first phase of this project was launched and consisted of an electronic assessment sent to all emergency departments (EDs) across the nation. A total of 5,017 hospitals with EDs were assessed with 4,150 hospitals responding-an 82.7% response rate 2 . Upon completion of the assessment, respondents received a score based on a 100-point scale representing their readiness to care for pediatric patients. The Assessment and the Score This document includes a copy of the assessment as well as the scoring matrix that was used to generate an overall pediatric readiness score for each participating hospital. This information can be helpful for hospitals as they launch quality improvement efforts and want to track changes in their score over time. The total number of points possible was 100. A score of 100 represents the essential components needed to establish a foundation for pediatric readiness, but is in no way inclusive of all the components recommended for pediatric readiness. Hospitals are encouraged to carefully review the Guidelines for Care of Children in the Emergency Department, which served as the basis for the assessment, to develop a comprehensive pediatric readiness program for a hospital 3, 4 . Determining which of the assessment questions would be scored and how heavily they would be scored was done by a group of clinical experts through a modified Delphi approach 5 . In developing the scoring criteria, the experts were asked to consider results of two recently published assessments on pediatric readiness of emergency departments 6, 7 , as well as recommendations from the Institute of Medicine report on the Future of Emergency Care in the United States 8 . How to Read This DocumentThis document contains all the questions from the pediatric readiness assessment. If a question in the assessment was used in the scoring, it will be followed by the number of points allotted to that question as shown in red in the example below:1. www.pediatricreadiness.org/About_PRP 2. www.pedsready.org/nationalResponseRate.aspx 3. Krug S, Gausche--Hill M. Guidelines for care of children in emergency departments.

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A significant proportion of US children do not have timely access to EDs with high pediatric readiness.

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.

BACKGROUND Pediatric readiness among US emergency departments is not universal. Trauma hospitals adhere to standards that may support day-to-day readiness for children. METHODS In 2013 4,146 emergency departments participated in the NPRP to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association survey found 1,247 self-identified trauma hospitals (levels 1, 2, 3, 4). Relationship between trauma hospital level and weighted pediatric readiness score (WPRS) on a 100-point scale was performed; significance was assessed using a Kruskal-Wallis test and pediatric readiness elements using χ2. Adjusted relative risks were calculated using modified Poisson regression, controlling for pediatric volume, hospital configuration, and geography. RESULTS The overall WPRS among all trauma hospitals (1,247) was 71.8. Among those not self-identified as a children's hospital or emergency department approved for pediatrics (EDAP) (1088), Level 1 and 2 trauma hospitals had higher WPRS than level 3 and 4 trauma hospitals, 83.5 and 71.8, respectively versus 64.9 and 62.6. Yet, compared with EDAP trauma hospitals (median 90.5), level 1 general trauma hospitals were less likely to have critical pediatric-specific elements. Common gaps among general trauma hospitals included presence of interfacility transfer agreements for children, measurement of pediatric weights solely in kilograms, quality improvement processes with pediatric-specific metrics, and disaster plans that include pediatric-specific needs. CONCLUSION Self-identified trauma hospital level may not translate to pediatric readiness in emergency departments. Across all levels of general non-EDAP, nonchildren's trauma hospitals, gaps in pediatric readiness exist. Nonchildren's hospital EDs (i.e., EDAPs) can be prepared to meet the emergency needs of all children and trauma hospital designation should incorporate these core elements of pediatric readiness. LEVEL OF EVIDENCE Care management, level III.

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