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. 2018 Mar:194:225-232.e1.
doi: 10.1016/j.jpeds.2017.10.074. Epub 2018 Jan 12.

Access to High Pediatric-Readiness Emergency Care in the United States

Kristin N Ray  1 , Lenora M Olson  2 , Elizabeth A Edgerton  3 , Michael Ely  2 , Marianne Gausche-Hill  4 , Patricia Schmuhl  2 , David J Wallace  5 , Jeremy M Kahn  6
Affiliations

Access to High Pediatric-Readiness Emergency Care in the United States

Kristin N Ray et al. J Pediatr. 2018 Mar.

Abstract

Objective: To determine the geographic accessibility of emergency departments (EDs) with high pediatric readiness by assessing the percentage of US children living within a 30-minute drive time of an ED with high pediatric readiness, as defined by collaboratively developed published guidelines.

Study design: In this cross-sectional analysis, we examined geographic access to an ED with high pediatric readiness among US children. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) of US hospitals based on the 2013 National Pediatric Readiness Project (NPRP) survey. A WPRS of 100 indicates that the ED meets the essential guidelines for pediatric readiness. Using estimated drive time from ZIP code centroids, we determined the proportions of US children living within a 30-minute drive time of an ED with a WPRS of 100 (maximum), 94.3 (90th percentile), and 83.6 (75th percentile).

Results: Although 93.7% of children could travel to any ED within 30 minutes, only 33.7% of children could travel to an ED with a WPRS of 100, 55.3% could travel to an ED with a WPRS at or above the 90th percentile, and 70.2% could travel to an ED with a WPRS at or above the 75th percentile. Among children within a 30-minute drive of an ED with the maximum WPRS, 90.9% lived closer to at least 1 alternative ED with a WPRS below the maximum. Access varied across census divisions, ranging from 14.9% of children in the East South Center to 56.2% in the Mid-Atlantic for EDs scoring a maximum WPRS.

Conclusion: A significant proportion of US children do not have timely access to EDs with high pediatric readiness.

Keywords: access; emergency department; geographic access; pediatric-ready.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

None
Figure: Percent of children within 30 minutes of driving time to ED with specified WPRS by census division, National Pediatric Readiness Project, 2013
Figure legend: Among children 0–14 years old, the percent of the population able to travel within 30 minutes to (A) any ED and to (B) EDs scoring at or above specified WPRS thresholds, specifically maximum WPRS (100), 90th percentile WPRS (94.3), and 75th percentile WPRS (83.6).
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