In analysis of US emergency departments, pediatric access to high-readiness hospitals declined modestly

U.S. hospitals vary widely in their readiness to provide high-quality emergency care for children, which translates into differing outcomes for critically ill and injured children. Several groups have launched efforts to improve pediatric readiness, but countervailing forces (including the COVID-19 pandemic) have hindered these efforts.

In a new study, researchers analyzed access to emergency departments (EDs) with high levels of pediatric readiness in the United States, examining not only changes in overall access but also how the changes varied by state and region. They found that pediatric access to high-readiness EDs declined modestly between 2013 and 2021, though some areas improved.

The study was conducted by researchers at Carnegie Mellon University, the University of Cincinnati, the University of Pittsburgh, the University of Utah, and Children’s National Health Systems. It is published in the Journal of Pediatrics.

“Research shows that millions of children in the United States lack timely access to EDs with high levels of readiness, which means that they are not within a 30-minute drive from an ED with a level of readiness associated with the best outcomes,” says Kristen S. Kurland, professor of architecture, information systems, and public policy at Carnegie Mellon’s Heinz College, who coauthored the study.

Children who are cared for at EDs with high levels of pediatric readiness have lower levels of mortality in the short and long term, resulting in more than 2,000 preventable pediatric deaths per year. To assess changes in access to high-readiness EDs between 2013 and 2021, researchers analyzed ED responses to assessments conducted by the National Pediatric Readiness Project (NPRP) linked to Census data.

High pediatric readiness EDs were defined as those scoring above the 75th percentile in the 2013 NPRP assessment. The study calculated the proportion of children with timely access (within a 30-minute drive) nationally, by state, and by hospital referral region, and also assessed changes over the study period. Given potential impacts of the COVID-19 pandemic on staffing, they conducted a secondary analysis excluding staffing-related readiness.

Between 2013 and 2021, the proportion of children with timely access to a high-readiness ED decreased from 70% to 67%, representing 2.1 million fewer children with timely access. In particular, hospitals in 2021 were less likely to have a dedicated pediatric inpatient ward but were otherwise generally similar. Declines in the number of children with timely access to an ED occurred in both urban and rural areas, but a greater proportion happened in urban areas.

However, there was wide variation underlying the changes, with many states and regions experiencing improvements in access exceeding 10 percentage points, while other areas lost access to these EDs. Since the pandemic resulted in losses of pediatric emergency care coordinators and other staff in some hospitals, the study excluded domains of readiness related to staffing. In doing so, researchers found that access to EDs with high equipment- and process-related readiness rose from 76% to 80%, a net gain of about 2.2 million children.

Therefore, while pediatric access to high-readiness EDs declined modestly over the study period, some areas saw meaningful improvements. Excluding staffing-related readiness, which may have been affected by the pandemic, the study charted an increase in access.

“Our study provides new insights into the effects of efforts to boost access to high-quality pediatric care in the United States,” explains Allan M. Joseph, assistant professor of pediatrics at the University of Cincinnati College of Medicine and an attending physician for the Pediatric Intensive Care Unit at Cincinnati Children's Hospital Medical Center, who led the study.

“We clearly demonstrate the capacity to improve access to high-readiness EDs, given the substantial increases in access we saw in some regions and states.” These efforts include partnerships with children’s hospitals, statewide policy initiatives such as pediatric facility verification programs, and improvements in equipment and care processes, say the authors.

Among the limitations of the study, the authors note that they did not account for emergency medical service dispatch times or travel patterns, and they assumed that all children had access to transportation via car, which may not be valid. In addition, conditions at the start of the COVID-19 pandemic may have affected results in ways that no longer apply to the delivery of emergency care.