Stretcherside nurses at the Marc and Laura Andreessen Pediatric Emergency Department at Stanford Health Care partnered with leadership to redesign pediatric staffing to create a pediatric-

Marc and Laura Andreessen Pediatric Emergency Department at Stanford Health Care

specific assignment model that recognizes the unique developmental and clinical needs of children and families. The initiative reduced standard nurse-to-patient ratios from 4:1 to 3:1, implemented a pediatric surge tool to proactively adjust staffing and improved workload balance while maintaining trauma readiness. Outcomes included a 13 percent improvement in teamwork and inclusivity and turnover below 1 percent. The successes were disseminated nationally through a poster presentation at the 2025 Magnet Conference.

Building on this work, the 22-bed department implemented the Modified Pediatric Emergency Department Overcrowding Scale to provide real-time assessment of departmental capacity and guide proactive staffing and patient flow decisions. The tool enables earlier surge recognition, resource allocation, and operational awareness during periods of high demand in the department that saw approximately 29,000 patient visits in 2025. Outcomes following the PEDOCS included an 18.75 percent reduction in patients leaving without being seen. The team’s work was published in the January 2026 issue of the Journal of Emergency Nursing, supporting broader adoption of pediatric-specific overcrowding strategies.