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," said Dr. Alpern. "We established actionable, best-practice targets grounded in real practice as goals to improve care for all children needing emergency care."
Dr. Alpern holds the George M. Eisenberg Professorship in Pediatrics.
Ann & Robert H. Lurie Children's Hospital of Chicago is a nonprofit organization committed to providing access to exceptional care for every child. It is the only independent, research-driven children's hospital in Illinois and one of less than 35 nationally. This is where the top doctors go to train, practice pediatric medicine, teach, advocate, research and stay up to date on the latest treatments. Exclusively focused on children, all Lurie Children's resources are devoted to serving their needs. Research at Lurie Children's is conducted through Stanley Manne Children's Research Institute, which is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is the pediatric training ground for Northwestern University Feinberg School of Medicine. It is ranked as one of the nation's top children's hospitals by U.S. News & World Report. Emergency medicine-focused research at Lurie Children's is conducted through the Grainger Research Program in Pediatric Emergency Medicine.
