A single-blind, matched-pair RCT in 17 general EDs in Ontario (October 2022–May 2025) evaluated a multi-component intervention — including a customized readiness report with discussion, pediatric resource toolkits, educational outreach, and ongoing support — versus report-only control on improving the weighted pediatric readiness score (WPRS; 0–100), reassessed ≥6 months post-intervention.
No significant improvement was found: mean WPRS change was −4.8 (SD 16.7) in intervention sites vs. +2.4 (SD 13.4) in controls (p = 0.4). Only 3 of 16 sites achieved clinically meaningful improvement (>10 points); 4 sites declined. Post-intervention WPRS ranged from 38.2 to 79.3, with quality improvement remaining the lowest-scoring domain.
- Small sample (16 EDs), limiting statistical power to detect modest effects. - Matched-pair design may not have fully controlled for site-level contextual factors driving the large variation in outcomes. - Single Canadian province limits generalizability to other health systems.
A low-intensity toolkit and educational outreach approach did not reliably raise pediatric readiness scores in general EDs — more intensive, context-tailored strategies (e.g., dedicated Pediatric Emergency Care Coordinators, QI collaboratives) are likely needed. Clinicians and ED leaders should not expect passive resource distribution alone to close readiness gaps.
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