U.S. Children Are Gradually Losing Access to Top Quality Emergency Care

Study finds overall staffing challenges and declining pediatric services within adult-focused hospitals to be eroding access in scattered rural and urban pockets

CINCINNATI, Oct. 6, 2025 /PRNewswire/ -- A new in-depth analysis of pediatric emergency care readiness reveals that America's children had less access to "highly ready" care in 2021 than they did in 2013—a concerning trend that has likely not improved in the past four years.

The study, published online Sept. 26, 2025, in the Journal of Pediatrics, was led by Allan Joseph, MD, MPH, (now at Cincinnati Children's) and a team of colleagues at the University of Pittsburgh and three other institutions. The study reflects the latest results from the federally funded National Pediatric Readiness Project (NPRP), originally launched in 2003.

"Our findings show a mix of changes in pediatric emergency care capability across the eight-year study period," Joseph says. "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 latest findings were assembled primarily by members of the Department of Health Policy & Management and the Division of Critical Care at the University of Pittsburgh. The senior author was Jeremy Kahn, MD, MS, who also led a similar analysis of the NPRP's 2013 report. 

Key findings

The project 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 study in 2024 shows to reduce 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 in the US was steady.
• The percentage of US children with timely access to a highly ready emergency department fell from 70.2% to 66.7%, which means over 2.1 million children lost access to top quality care. Notably, the loss of access declined faster for children in urban areas vs rural areas.
• Across the nation, approximately 1 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 state-wide policies to verify pediatric care capabilities appeared to help improve readiness scores.

Study Provides Data for Planning

As part of a data-sharing agreement, the latest report does not specify which hospitals and which regions face the most serious declines in readiness. Nor does the study rank locations with the most outstanding readiness. Instead, each participating institution receives a report of where it stands relative to national averages.

"In the United States, healthcare services are highly localized. While industry-wide 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," Kahn says.

The co-authors did call attention to a few efforts to boost pediatric emergency care readiness.

For example, in Maryland, a PediTree decision tool is available to help emergency clinicians triage cases and route more severe cases to highly ready facilities.

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.

Meanwhile, a mix of state level proposals may play a role. Some lawmakers are calling to require all emergency departments to report pediatric care readiness with findings to be made public. Some are considering formal rules to require EMS services to take children straight to a highly-ready emergency department, even if that means bypassing a closer hospital.  

What's next?

While this study's data period ended in 2021, the tracking team has seen anecdotal signs that readiness continues to erode, Joseph says. Another national assessment by the NPRP is planned to be conducted in 2026, with results released later.

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SOURCE Cincinnati Children's Hospital Medical Center