Study defines realistic performance goals for pediatric emergency departments

A large, multi-center study led by Ann & Robert H. Lurie Children's Hospital of Chicago derived "achievable benchmarks of care" (ABCs) using electronic health record data, which allows pediatric emergency departments across the country to set high yet realistic performance goals. The new benchmarks are based on high achievers – a shift away from relying on peer averages in performance metrics. The study is published in JAMA Network Open.

"Using 'average' performance as a benchmark fails to motivate progress toward an achievable goal," said lead author Elizabeth Alpern, MD, MSCE, Division Head of Emergency Medicine at Lurie Children's, Executive Vice Chair and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "The new benchmarks provide a more meaningful target than means or medians, highlighting gaps between typical performance and what top-performing clinicians can achieve in real-world practice."

Dr. Alpern and colleagues analyzed over 5.3 million visits at nine pediatric emergency departments and three community affiliate sites participating in the Pediatric Emergency Care Applied Research Network (PECARN) Registry of electronic health records. They calculated ABCs for common pediatric emergency concerns (asthma, infections and pain), emergency readiness (vital sign assessment, timeliness of care and throughput measures), and quality (return visits). The study included data over a seven-year period (2017-2024).

Researchers found a marked variation in achievable performance across domains, especially for measures more directly within clinicians' or sites' locus of control (such as pain reduction, asthma management and vital sign documentation), while other measures (such as return visits with admission and antibiotic stewardship for viral illness) show little variation and possible ceiling effects. Measures of emergency department and system throughput or timeliness worsened over time, underscoring system-level pressures and the influence of external factors, such as COVID-19 era volume changes.

This work provides benchmarks for important performance measures across a large multicenter network, across years of practice and across care settings to provide achievable goals and focus on where gaps are largest to improve care for children in the emergency department. We established actionable, best-practice targets grounded in real practice as goals to improve care for all children needing emergency care."

Dr. Elizabeth Alpern, MD, MSCE, Division Head of Emergency Medicine, Lurie Children's

Dr. Alpern holds the George M. Eisenberg Professorship in Pediatrics.