#United States #Cincinnati #Health Care #Cincinnati Children's #Pediatric Emergency

Declining Access to Emergency Care for U.S. Children

A recent detailed analysis highlights a troubling trend: children's access to high-quality emergency healthcare in the United States has been on a downward trajectory. In a study published on September 26, 2025, in the Journal of Pediatrics, researchers revealed that in 2021, children were less likely than in 2013 to access what is classified as "highly ready" emergency care. This is alarming news for the approximately 2.1 million children who have lost access to timely and quality emergency services over this period.

The study, which involved researchers from Cincinnati Children's Hospital Medical Center and the University of Pittsburgh, is part of the federally funded National Pediatric Readiness Project (NPRP). It evaluated pediatric emergency care readiness at over 4,600 hospitals, assessing factors such as regional coordination, staffing levels, quality improvement efforts, and access to necessary equipment. The results showed that emergency departments have become less capable of delivering essential services to children, particularly in urban areas, although rural regions also lagged significantly.

Key Findings of the Study

The overall findings from the NPRP analysis exposed numerous concerning trends:

• - Fewer Emergency Departments for Pediatrics: The number of emergency departments (EDs) equipped to handle pediatric cases decreased from 4,681 to 4,660, despite a steady population of children in the U.S.
• - Declining Timely Access: The percentage of children with timely access to a highly ready emergency department saw a significant drop from 70.2% to 66.7%. This decline resulted in over 2.1 million children being cut off from quality emergency care services.
• - General Decline in Access: Across the nation, approximately 1 million children lost access to any emergency department during the assessed period, highlighting a widespread issue.

While the data indicates a national decline, some regions experienced positive changes. Local collaborations between children's hospitals and statewide initiatives aimed at verifying pediatric care capabilities helped some areas improve their readiness scores. However, detailed data revealing specific hospitals or regions that performed poorly was not released due to confidentiality agreements.

Challenges Facing Pediatric Emergency Care

The decline in pediatric emergency care access can be attributed to several intersecting factors:
1. Staffing Shortages: Many hospitals are grappling with staffing challenges that prevent them from providing adequate pediatric services.
2. Rural Hospital Closures: The steady closure of rural hospitals exacerbated accessibility issues, particularly for children in those underserved areas.
3. Budget Constraints: Financial limitations have forced some hospitals to scale back their pediatric programs, further reducing availability.

In response to these challenges, some initiatives have been implemented to enhance readiness in pediatric emergency care. For example, Maryland has adopted a PediTree decision tool that helps emergency clinicians effectively triage and redirect severe cases to well-equipped facilities. At the national level, the American College of Surgeons now mandates regular pediatric readiness assessments for trauma centers to maintain their accreditation.

The Path Ahead

Despite these challenges, there is a glimmer of hope. Policymakers are increasingly discussing legislation that would require emergency departments to disclose their pediatric readiness levels, thus making this information public. Additionally, some are proposing regulations that would mandate Emergency Medical Services (EMS) to transport children directly to high-readiness facilities, even if that means bypassing closer hospitals.

While the study's data only extends to 2021, anecdotal evidence suggests that the downward trend in pediatric emergency care access may continue. Fortunately, the NPRP plans to conduct another national assessment in 2026, aiming to identify and respond to ongoing challenges in pediatric emergency services. The health landscape is shifting, and it is essential for communities to advocate for improved access to care for their children.

In summary, as access to quality emergency care for children diminishes, it calls for immediate attention from healthcare providers, policymakers, and communities to reverse this trend and ensure that children receive the high-quality care they deserve.