Care for the clinically deteriorating child, defined as a pediatric patient (<18 years of age) whose clinical state worsens during hospitalization, leading to an increase in their risk of morbidity (eg, organ dysfunction, protracted hospital stay, disability, or death), often requires increased monitoring, interventions, medications, and nursing care. Although more than half of all hospitalizations for children in the United States occur across 3000 community hospitals (general, nonchildren’s hospitals), there are no national guidelines on assessing optimal readiness for children who worsen clinically after admission. With many hospitalizations occurring in facilities with a low daily pediatric census, community hospitals often face challenges that result from limited exposure to ill pediatric patients, limited access to critical care personnel (eg, fellowship-trained pediatric emergency medicine physicians or pediatric-specific critical care nurses), hospital focus on adult services, limited opportunities for pediatric training, and a lack of continuing competency assessments. Additionally,...

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