The Impact of a Pediatric Emergency Department Facility Verification System on Pediatric Mortality Rates in Arizona

Background: The Emergency Medical Services for Children State Partnership Program, as well as the Institute of Medicine report on pediatric emergency care, encourages recognition of emergency departments (EDs) through categorization and verification systems. Although pediatric verification programs are associated with greater pediatric readiness, clinical outcome data have been lacking to track the effects and patient-centered outcomes by implementing such programs. Objective: To describe pediatric mortality rates prior to and after implementation of a pediatric emergency facility verification system in Arizona. Methods: This was a cross-sectional study conducted using data from ED visits between 2011 and 2014 recorded in the Arizona Hospital Discharge Database. The primary outcome measure was the mortality rate for ED visits by patients under 18 years old. Rates were compared prior to and after facility certification by the Arizona Pediatric Prepared Emergency Care program. Results: The total number of ED visits by children during the study period was 1,928,409. Of these, 1,127,294 were at facilities undergoing certification. For hospitals becoming certified, overall ED mortality rates were 35.2 deaths/100,000 ED visits (95% confidence interval [CI] 29.5-41.7) in the precertification analysis and 34.4 deaths/100,000 ED visits (95% CI 30.4-38.9) in the postcertification analysis. The injury-related ED visit mortality rate for certified hospitals showed a decrease from 40.0 injury-related deaths/100,000 ED visits (95% CI 28.6-54.4) in the precertification analysis to 25.8 injury-related deaths/100,000 ED visits (95% CI 18.7-34.8) in the postcertification analysis. Conclusion: The implementation of the Arizona pediatric ED verification system was associated with a trend toward lower mortality. These results offer a platform for further research on pediatric ED preparedness efforts and their effects on improved patient outcomes.