Study defines realistic performance goals for pediatric emergency departments

A large, multi-center study led by Ann and Robert H. Lurie Children’s Hospital of Chicago used electronic health record data to derive “Achievable Benchmarks of Care” (ABCs), which allow pediatric emergency departments across the country to set high but realistic performance goals. The new benchmarks are based on high achievers – a shift from relying on peer averages in performance metrics. This study has been 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 chief of emergency medicine at Lurie Children’s, executive vice president and professor of pediatrics at Northwestern University Feinberg School of Medicine. “The new benchmarks provide more meaningful targets than instruments or mediators, highlighting the gap between typical performance and what top-performing physicians can achieve in real-world practice.”

Dr. Alpern and colleagues analyzed more than 5.3 million visits at nine pediatric emergency departments and three community affiliated 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, infection, and pain), emergency preparedness (vital signs assessment, timeliness of care, and throughput measures), and quality (return visits). The study included data over a seven-year period (2017-2024).

The researchers found a notable variation in achievable performance across domains, particularly for more direct measures within the physicians’ or sites’ control area (such as pain reduction, asthma management and vital signs documentation), while other measures (such as return visits with admission and antibiotic management for viral illness) showed little variation and potential ceiling effects. Measures of emergency department and system throughput or timeliness worsened over time, highlighting system-level pressures and the impact of external factors, such as changes in volume in the COVID-19 era.

This work provides benchmarks for key performance measures across large multicenter networks, across years of practice, and across care settings to provide achievable goals and focus on the largest gaps in improving care for children in the emergency department. We established actionable, best practice targets based on actual behavior as the goal of improving care for all children who require emergency care.”

Dr. Elizabeth Alpern, MD, MSCE, Division Chief of Emergency Medicine, Lurie Children’s

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