Every emergency department is built on a promise to be ready for whoever walks through the door. Yet when the patient is a child, national data suggests most are not.
A 2024 study published in JAMA Network Open found that only 17.4% of U.S. hospitals were fully prepared for pediatric emergencies, a figure that has stagnated since 2013.
With 8 out of 10 pediatric emergency visits occurring outside of major children’s hospitals nationwide, the gap represents a significant clinical and operational risk for health systems that have underinvested in pediatric infrastructure.
Steve Narang, MD, president of Inova Fairfax Medical Campus in Falls Church, Va., and president of Inova’s pediatric service line, warns that risk is no longer one health systems can afford to passively manage.
Dr. Narang, a pediatrician, has spent the last few years overseeing a major initiative to close pediatric readiness gaps across Inova’s network in Northern Virginia. The effort began with a straightforward but ambitious commitment: “Any child treated anywhere in the Inova system should have access to the same pediatric standards, expertise and safety systems they would expect at Inova L.J. Murphy Children’s Hospital,” Dr. Narang said.
He recently spoke with Becker’s about how Inova built its approach, the returns the system has seen and advice for leaders looking to close the gap at their own organizations.
A 3-step framework to improve pediatric ED readiness
When Dr. Narang joined Inova in 2019, one of his first priorities was evaluating whether the system was truly designed around the needs of children. Inova opened its 226-bed children’s hospital on the Inova Fairfax Medical Campus in 2016, offering comprehensive pediatric care on its flagship campus. However, Dr. Narang saw an opportunity to extend that standard across the entire system.
“We serve a rapidly growing Northern Virginia community, and families shouldn’t have to think about geography or hospital choice in an emergency,” he said. “Our commitment was straightforward but intentional: a child’s ZIP code — or which Inova campus they walk into — should never determine the quality of pediatric emergency care they receive.”
Rather than treating pediatric readiness as a single initiative, Inova developed a framework with three components to guide meaningful change, rooted in a broader culture shift across the system.
1. People. First, the system identified clinicians and staff across the organization who were passionate about pediatric care and brought them together to identify opportunities to improve care delivery, particularly in the ED. The system then went on an aggressive national recruitment push, ultimately hiring more than 100 pediatric subspecialists across nearly 30 specialties.
2. Playbook. With the right people in place, Inova turned to training and standardization. The system developed protocols, quality improvement methodologies and safety systems designed specifically for pediatric populations. Teams practiced care protocols through simulation to ensure the playbook held up under real-world pressure.
3. Platform. The final layer was technology. Inova invested in inpatient telemedicine capabilities to make pediatric expertise accessible beyond the four walls of the children’s hospital, extending specialist support across the broader system and, ideally, into the community.
“We were very deliberate about starting with people before process,” Dr. Narang said. “We identified nurses, physicians and staff across all five hospitals who were deeply committed to pediatric care and asked them to help lead the work locally. Creating pediatric-focused nurse–physician dyads, investing in training and simulation, and formally unifying the pediatric service line wasn’t just an organizational change — it signaled a shared standard. Children are not small adults, and readiness for them has to be intentional wherever they present.”
The ROI of pediatric readiness
Insufficient reimbursement, compensation and talent shortages have long stressed the nation’s pediatric care infrastructure, spurring many systems to scale back specialty care. A 2025 JAMA Pediatrics study found that U.S. hospitals closed nearly 30% of inpatient pediatric units between 2008 and 2022.
Dr. Narang acknowledged this challenging financial reality but argued the calculus changes when leaders look beyond the immediate balance sheet.
Since implementing its changes, Inova has seen a 32% decrease in visit times — improving patient experience while also increasing capacity and throughput.
Beyond operational metrics, Dr. Narang said health systems are fundamentally in the trust business. When a family trusts a system enough to bring their child through its doors, that trust extends to the rest of the family, future visits and long-term patient loyalty. Pediatric care, in his view, is not a cost center to be minimized but a relationship builder that strengthens the entire system.
What’s more, a 2024 study from the University of Texas at Austin found preparing an ED to be pediatric-ready can cost between $4 and $48 per patient.
For CEOs and service line leaders who recognize the pediatric readiness gap but are unsure where to begin, Dr. Narang recommends starting with a mindset shift. Leaders need to move past common misconceptions about pediatric care — that children are just small adults, or that the difficult financial environment warrants less investment in pediatric care — before meaningful progress is possible.
From there, he encouraged systems to follow evidence-based guidelines established by the National Pediatric Readiness Project and to consider collaborative models or partnerships with other organizations that can improve access to subspecialty expertise without requiring every system to build from scratch. For example, Inova has had a long-standing pediatric clinical partnership with Washington, D.C.-based Children’s National Health System through which Inova co-employs pediatric subspecialists to deliver care in Northern Virginia.
Ultimately, Dr. Narang said, the case for investment comes back to a simple question of what health systems owe the communities they serve.
“When families bring their child to an emergency department, they’re placing an extraordinary amount of trust in the system. They’re not thinking about margins, workforce constraints or capital cycles — they’re thinking about their child,” Dr. Narang said. “Pediatric readiness shouldn’t be viewed as optional or aspirational. If health systems commit to the mindset, follow the evidence and partner thoughtfully, closing the readiness gap is both achievable and urgent.”
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