Achievable Benchmarks of Care in Pediatric Emergency Departments.

Abstract

Achievable benchmarks of care (ABCs) are a process by which performance is anchored on a select high-achieving group. ABCs can motivate systemic quality improvement toward realistically achievable goals. The establishment of multisite ABCs in pediatric emergency medicine has been limited. To report ABCs for pediatric emergency care management (encounters with asthma, infections, or pain), readiness (vital measurement, timeliness, and throughput), and quality (return visits). This cross-sectional study analyzed visits at 12 emergency department (9 pediatric emergency departments [EDs] and 3 affiliate community sites) from January 1, 2017, to December 31, 2024, in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. Data were analyzed from August 2025 to March 2026. An ABC was calculated for each performance measure and derived from the 10% of visits attended to by the highest-performing clinicians both within individual sites and in the database overall using the pared mean method. ABCs for each performance measure are described at the network and site level by year and overall. A total of 5 302 587 visits (median [IQR] patient age, 5.1 [1.8-11.0] years; 52.6% male patients) were included, of which 4 364 658 were quaternary pediatric ED visits and 937 929 were to affiliate community sites. Quality metrics varied across network sites and settings, with ranges of 56.8% to 99.3% for vital sign documentation, 61.4% to 92.6% for 2-point pain reduction for encounters with long bone fractures, and 93.1% to 99.2% for systemic corticosteroids given for visits with asthma exacerbation. Return visit with admission rate and antibiotic stewardship metrics had minimal variability across sites and care settings. There was significant ABC variability in throughput metrics (time-to-clinician and length of stay) across sites and pediatric ED vs affiliate setting. Overall, throughput metrics worsened over the study period. Performance measures more within clinicians' locus of control (care of encounters with asthma, pain reduction in encounters for long bone fractures) had wider variation between the site's mean performance and ABC, indicating practice variation within the sites. This cross-sectional study from 12 EDs established ABCs for pediatric care management using electronic health record data. These can be used to compare quality outcomes of pediatric emergency care and provide benchmarking relevant to settings that care for children.