Building Pediatric Readiness Across a Health System: Evaluation of a Pediatric Emergency Department Affiliation Program.

INTRODUCTION: Pediatric readiness in emergency departments is associated with improved patient outcomes; however, variability in preparedness persists across health care settings. This quality improvement project evaluated baseline pediatric readiness across a network of affiliated emergency departments and assessed the impact of a systemwide Pediatric Emergency Department Affiliation Program. METHODS: A pre-post design compared National Pediatric Readness Project (NPRP) assessment scores collected during site onboarding (2021-2023) with scores from the 2026 national assessment. To promote consistency, baseline and follow-up assessments were each completed by a single program coordinator. Interventions included implementation of Pediatric Emergency Care Champions (PECCs), standardized clinical pathways, simulation-based education, and ongoing quality improvement and operational support. Twenty-five emergency departments were included. A paired-samples t test was used to compare scores. RESULTS: Baseline NPRP scores averaged 66.3 (SD = 6.63) and varied across sites. At follow-up, all participating emergency departments achieved an NPRP score of 100, indicating full alignment with national pediatric readiness standards. Mean scores increased by 33.7 points. The improvement was statistically significant, t(24) = 25.41, p < .001. Gains were observed across all NPRP domains, with the largest improvements in Coordination of Care and Equipment and Supplies. DISCUSSION: A structured, systemwide affiliation program was associated with substantial improvements in pediatric readiness across diverse emergency care settings. Programs that incorporate pediatric leadership, standardized pathways, simulation-based education, and continuous quality improvement support may strengthen emergency nurses' preparedness and promote consistent, high-quality pediatric emergency care.