Pediatric emergency departments are under increasing pressure to deliver faster, safer, and more consistent care, but defining “excellent” care has remained a challenge. A new study from the Pediatric Emergency Care Applied Research Network (PECARN), published in JAMA Network Open, establishes “Achievable Benchmarks of Care” (ABC) using data from more than 5.3 million pediatric emergency department visits across children’s hospitals and affiliate community sites [1]. The benchmarks span key areas of pediatric emergency care, including timeliness of evaluation, emergency department throughput, asthma management, pain reassessment, and avoidance of unnecessary antibiotic use. Importantly, the work is designed to support practical improvement efforts at the bedside.
What do these benchmarks look like in practice? Rather than holding hospitals to the average, the study reports the level top-performing sites are already reaching [1]:
- Timeliness: a child seen by a clinician within about 20 minutes of arrival
- Throughput: a total visit of roughly 110 minutes for children discharged home, with as few as 3.5% leaving before being seen
- Asthma care: systemic steroids given in 97.8% of asthma-flare visits
- Pain management: a meaningful drop in pain (≥2 points on a 10-point scale) in about 80% of children with a broken arm or leg, with pain reassessed in 97% of those visits
- Antibiotic stewardship: unnecessary antibiotics for a viral illness given in just 0.2% of visits
These reflect what the highest-performing clinicians actually reached — not an average, and not an ideal.
Educational and quality initiatives are most effective when they focus on achievable excellence. “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.” [1]
By grounding quality measurement in achievable performance demonstrated across real pediatric emergency settings, the study provides hospitals with meaningful targets that can drive improvement without losing sight of clinical realities. The findings also reinforce the growing role of collaborative registries like the PECARN Registry [2] in helping health systems learn from one another, identify gaps in care, and improve outcomes for children nationwide.
References
- Alpern ER, Ramgopal S, Olsen CS, et al; for the PECARN Registry Study Group. Achievable benchmarks of care in pediatric emergency departments. JAMA Netw Open. 2026;9(5):e2613391. PMID: 42154467. doi:10.1001/jamanetworkopen.2026.13391
- Deakyne Davies SJ, Grundmeier RW, Campos DA, et al; Pediatric Emergency Care Applied Research Network. The Pediatric Emergency Care Applied Research Network Registry: a multicenter electronic health record registry of pediatric emergency care. Appl Clin Inform. 2018;9(2):366-376. PMID: 29791930. doi:10.1055/s-0038-1651496
