On rounds, the decisions come quickly. Does this child with pneumonia need another X-ray? Will a blood culture change the plan? Is it time to move from an IV antibiotic to an oral version?
Each choice belongs to one patient and one moment.
Taken together, across a hospital and across a year, they reveal how care is delivered.
They also show where a small change in practice could spare children unnecessary interventions, free staff and capacity, and reduce the cost of care.
That is the value of the new Pediatric Hospital Medicine Achievable Benchmarks of Care (ABC) Report Card. It provides leading-performance benchmarks for 115 measures across 13 common conditions, helping hospitals identify opportunities to improve the quality and value of pediatric hospital care while reducing unnecessary interventions.
The goal is not to add another scorecard to an already crowded landscape. The goal is to make it easier to identify where focused improvement efforts may have the greatest impact. Because when resources, time, and attention are limited, choosing the right targets can matter as much as the improvement effort itself.
A closer look at daily practice
Most hospitals already monitor length of stay and readmissions closely. The harder question is what drives those outcomes in the first place. The ABC Report Card addresses the daily decisions that shape a child’s hospitalization: imaging, laboratory tests, procedures, medication selection, and the route of treatment.
Those measures are familiar to anyone who cares for hospitalized children. We know the tension. Diagnostic tests may seem natural to order when obtaining IV access to avoid future pokes or provide reassurance even when it is unlikely to change management. A broad-spectrum antibiotic may seem safer in the moment. An IV medication may continue because the child already has access and the team is moving fast. Yet none of those decisions occurs in a vacuum.
The report card makes cumulative patterns visible.
It gives clinical teams a way to look beyond individual cases, test their assumptions against strong performance elsewhere, and identify the habits, culture, or systems that may be driving overuse locally and nationally.
From a measure to change
A benchmark does not explain why performance differs. That work remains local, and that’s where its clinical value begins.
If imaging use stands out, the answer may sit in a pathway, an order set, access to prior images, the way uncertainty is handled overnight, or how evidence is interpreted and applied locally. If children remain on IV antibiotics longer, the obstacle may be unclear transition criteria, pharmacy workflow, discharge timing, or confidence in follow-up.
Many of these measures already have strong national evidence-based guidance behind them. Hospitals can start with that evidence, examine how care actually moves through their own system, and learn from peers whose results helped set the achievable benchmarks.
The aim is not uniformity for its own sake. It is high quality, necessary, and reliable care, informed by evidence, with room for clinical judgment when a child’s needs call for a different course.
A stronger way to learn together
The report card can also change how we work across hospitals.
When the same measure emerges as an opportunity in many places, the Children’s Hospital Association can connect the teams doing the work with hospitals that have already made progress. That creates the conditions for practical learning through shared experiences: what changed, who had to be involved, where did efforts stall, and what helped sustain improvement.
Children’s hospitals have used shared data and collaborative improvement approaches to solve difficult problems before. The ABC Report Card gives us a broader set of metrics to optimize the clinical decisions we make every day. It turns those decisions into something we can see, study, and improve.
For those of us at the bedside, the promise is concrete: fewer tests that do not change care, better use of antibiotics, earlier movement toward home when a child is ready, and increased capacity and efficiency for patients needing hospital-based care.
The benchmarks show where the field’s current best performance stands. Our job is to learn from those who achieved it and carry those lessons into the next child’s care.
The ABC Report Card was developed for participants in CHA’s Pediatric Health Information System (PHIS). The Pediatrics manuscript provides all the metric definitions so non-PHIS hospitals can replicate our methods with their own data and generate comparisons to our benchmarks.
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