This article regarding the cost of upgrading emergency departments to be “ready” for sick children has been bouncing around in the background since its publication, with some initial lay press coverage.
The general concept here is obviously laudable and the culmination of at least a decade of hard work from these authors and the team involved – with the ultimate goal of ensuring each emergency department in the country is capable of caring for critically unwell children. The gist of this most recent publication builds upon their prior work to, effectively, estimate the overall cost (~$200M) of improving “pediatric readiness”. Using that total cost, they then translate this into humanizing terms by referencing the total cost per child it might require in different states, and the number of pediatric lives saved annually.
As can be readily gleaned from this sort of thought experiment, these estimates rely upon a nested set of foundational assumptions, all of which are touched upon by prior work by this group. There are surveys of subsets of emergency departments regarding “readiness“, which involve questions such as the presence of pediatric-sized airway devices and staff dedicated to upkeep of various pediatric support. Then, they use these data and salary estimates to come up with the institutional costs of readiness. Then, they have another set of work looking at the odds ratios for increased poor outcomes at departments whose “readiness” is in the lowest percentiles, and this work is extrapolated to determine the lives saved.
Each of these pieces of work, in isolation, is reasonable, but represents a bit of a house of cards. The likelihood of imprecision is magnified as the estimates are combined. For example, how direct is the correlation between “readiness” based on certain equipment and pediatric survival, if the ED in question is a critical access hospital with low annual census? Is the cost of true clinical readiness just a part-time FTE of a nurse, or should it realistically involve the costs of skill upkeep for nurses and physicians with education or simulation?
I suspect, overall, these data understate the costs and overstate the return on investment. That said, this is still critical work even just to describe the landscape and take a stab at the scope of funding required. Likely, the best next step would be to target specific profiles of institutions, and specific types of investment, where such investment is likely to have the highest yield – as a first step on the journey towards universal readiness.
“State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved”
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825748