National Pediatric Readiness Project: The Online Assessment Tool & Immediate Feedback Loop

Background:  The Emergency Medical Services for Children (EMSC) Program implemented the National Pediatric Readiness Project, a national quality improvement initiative to ensure that all emergency departments (EDs) are ready to care for children.  To gather benchmark data regarding preparedness to care for children, a web-based survey was deployed to hospital EDs, based on the 2009 “Guidelines for the Care of Children in the Emergency Department.” 

Program background:  In early 2012, a pilot test conducted in California achieved a 90% response rate of its 300+ hospitals. In late 2012, field tests were conducted in three states (518 EDs) with an average response rate of 99.3%. In January 2013, the EMSC National Resource Center (NRC) and the National EMSC Data Analysis Resource Center (NEDARC) began collaborating in the deployment of the survey in the remaining 57 U.S. states and territories. More than 5,000 hospitals are included. NEDARC provides data coordinating services, including the survey sampling frame and the administration of the survey using a secure website that provides respondents with immediate feedback in the form of a gap analysis.  State response rates are monitored and updated daily on the survey website. The EMSC NRC employs a mix of communication strategies to raise overall awareness of the project and increase survey completion rates. Strategies include deployment of the direct mail campaign; a website and collateral publications, including an ED-based quality improvement toolkit; social media promotions; and a targeted public relations campaign that utilizes state-level “champion” teams, and national-level targeted outreach to stakeholders. 

Evaluation Methods and Results:  The survey was shortened after the California pilot test. The three field test states helped determine if additional barriers where effectively addressed. Among the barriers identified: (1) obtaining buy-in from state-level “champions” to participate in a long-term project for which they would receive no funding to help offset implementation costs and (2) overcoming EDs’ fatigued with “yet another” survey coupled with fears that their participation may directly impact their public image should they score low on the survey. State-level champions received weekly reports tracking their state’s survey response rate and were encouraged to contact non-respondents.  The NRC and NEDARC engaged in weekly discussions focusing on strategies to support states with low response rates. The field test states achieved a response rate of 99%. Currently, 13 states and U.S. territories have completed the survey representing an 82% response rate. 

Conclusions:  Employing a four-touch direct mail strategy, coupled with a state-level project management plan, an active web/social media presence, and a comprehensive public relations campaign resulted in survey completion rates that exceed the typical 60% response rate peer-reviewed journals require for publication of survey research. 

Implications for research and/or practice:  The EMSC Program implemented a tested web-based survey along with a comprehensive, multi-layered communications strategy to increase participation in a nationwide survey of ED pediatric preparedness that can be replicated for other national and state programmatic issues/goals. This survey will provide the project with benchmark data to initiate quality improvement measures designed to improve the emergency care of children.