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U.S. children had less access to “highly ready” emergency care readiness in 2021 than they did in 2013, according to the latest results from the National Pediatric Readiness Project. This trend likely has not changed over the past four years.
“Our findings show a mix of changes in pediatric emergency care capability across the eight-year study period," said Dr. Allan Joseph of Cincinnati Children's Hospital Medical Center, who led the study. "In some areas, technology upgrades and better processes have resulted in notable improvements in readiness. However, in many areas, such improvements have been offset by staffing shortages, rural hospital closures and budget challenges that have caused some hospitals to cut back on pediatric capacity."
The study, published in the Journal of Pediatrics, assessed the pediatric care readiness of more than 4,600 emergency departments, including services based at adult-focused and pediatric-focused hospitals. Rating factors include regional coordination, staffing levels and skills, meeting recommended practice standards, demonstrating quality-improvement efforts and more. About one-third of points are related to equipment and supplies.
Emergency systems are considered highly ready to serve children when they reach or exceed 88 points on a 100-point scale, a level that a 2024 study showed reduces mortality when treating severely ill children. Children were considered to have timely access if they lived within 30 minutes of such centers. Among the findings:
- The overall number of emergency departments serving children declined from 4,681 to 4,660, even as the overall population of children remained steady.
- The percentage of U.S. children with timely access to a highly ready emergency department fell from 70% to 67%, which means more than 2.1 million children lost access to top-quality care.
- Across the nation, approximately one million children lost timely access to any emergency department, highly ready or not, during the study period.
- The study also documented significant improvements in some states and regions, where local partnerships with children's hospitals and statewide policies to verify pediatric care capabilities appeared to help improve readiness scores.
The report doesn’t specify which hospitals and regions face the most serious declines in readiness or rank locations with the most outstanding readiness. Instead, each participating institution received a report of where it stands relative to national averages.
"In the United States, health care services are highly localized,” said Dr. Jeremy Kahn, senior author of the report. “While industrywide recommended best practices do exist and resources are available at the national and state level to help hospitals improve, it will ultimately be up to each affected community to decide how best to respond to their readiness status."
At the national level, the American College of Surgeons has begun requiring all levels of trauma centers to complete regular pediatric readiness assessments to obtain or maintain recognition from the organization. Previously, it was mostly hospitals that expected to score well that took the time to complete the process. Joseph predicts this process also may increase expectations for pediatric readiness.
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