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.

BACKGROUND: Emergency departments (EDs) vary in their level of readiness to care for pediatric emergencies. We evaluated the effect of ED pediatric readiness on the mortality of critically ill children. METHODS: We conducted a retrospective cohort study in Florida, Iowa, Massachusetts, Nebraska, and New York, focusing on patients aged 0 to 18 years with critical illness, defined as requiring intensive care admission or experiencing death during the encounter. We used ED and inpatient administrative data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project linked to hospital-specific data from the 2013 National Pediatric Readiness Project. The relationship between hospital-specific pediatric readiness and encounter mortality in the entire cohort and in condition-specific subgroups was evaluated by using multivariable logistic regression and fractional polynomials. RESULTS: We studied 20 483 critically ill children presenting to 426 hospitals. The median weighted pediatric readiness score was 74.8 (interquartile range: 59.3-88.0; range: 29.6-100). Unadjusted in-hospital mortality decreased with increasing readiness score (mortality by lowest to highest readiness quartile: 11.1%, 5.4%, 4.9%, and 3.4%; P , .001 for trend). Adjusting for age, chronic complex conditions, and severity of illness, presentation to a hospital in the highest readiness quartile was associated with decreased odds of in-hospital mortality (adjusted odds ratio compared with the lowest quartile: 0.25; 95% confidence interval: 0.18-0.37; P , .001). Similar results were seen in specific subgroups. CONCLUSIONS: Presentation to hospitals with a high pediatric readiness score is associated with decreased mortality. Efforts to increase ED readiness for pediatric emergencies may improve patient outcomes. WHAT'S KNOWN ON THIS SUBJECT: The majority of children present to general emergency departments (EDs) that may be underprepared to care for them. Previous work has evaluated the pediatric readiness of EDs, but it is unknown whether pediatric readiness is associated with improved patient outcomes. WHAT THIS STUDY ADDS: Presentation to an ED with lower pediatric readiness was associated with increased risk-adjusted mortality for children with critical illness. Efforts to improve ED pediatric readiness may reduce mortality for these children.

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Objectives: Assessing outcomes after pediatric critical illness is imperative to evaluate practice and improve recovery of patients and their families. We conducted a scoping review of the literature to identify domains and instruments previously used to evaluate these outcomes. Design: Scoping review. Setting: We queried PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials Registry for studies evaluating pediatric critical care survivors or their families published between 1970 and 2017. We identified articles using key words related to pediatric critical illness and outcome domains. We excluded articles if the majority of patients were greater than 18 years old or less than 1 month old, mortality was the sole outcome, or only instrument psychometrics or procedural outcomes were reported. We used dual review for article selection and data extraction and categorized outcomes by domain (overall health, emotional, physical, cognitive, health-related quality of life, social, family). Subjects: Manuscripts evaluating outcomes after pediatric critical illness. Interventions: None. Measurements and Main Results: Of 60,349 citations, 407 articles met inclusion criteria; 87% were published after 2000. Study designs included observational (85%), interventional (7%), qualitative (5%), and mixed methods (3%). Populations most frequently evaluated were traumatic brain injury (n = 96), general pediatric critical illness (n = 87), and congenital heart disease (n = 72). Family members were evaluated in 74 studies (18%). Studies used a median of 2 instruments (interquartile range 1–4 instruments) and evaluated a median of 2 domains (interquartile range 2–3 domains). Social (n = 223), cognitive (n = 183), and overall health (n = 161) domains were most frequently studied. Across studies, 366 unique instruments were used, most frequently the Wechsler and Glasgow Outcome Scales. Individual domains were evaluated using a median of 77 instruments (interquartile range 39–87 instruments). Conclusions: A comprehensive, generalizable understanding of outcomes after pediatric critical illness is limited by heterogeneity in methodology, populations, domains, and instruments. Developing assessment standards may improve understanding of postdischarge outcomes and support development of interventions after pediatric critical illness.