To assess changes in access to high readiness emergency departments (EDs) between the 2013 and 2021 editions of the National Pediatric Readiness Project (NPRP) assessments.

We performed a geospatial analysis of ED responses to the NPRP assessments, linked to national census data. We defined high pediatric readiness EDs as those scoring above the 75th percentile in the 2013 assessment. We defined timely access as living within a 30-minute drive of such an ED. We calculated the proportion of children with timely access nationally, by state, and by hospital referral region, and also assessed changes over time. Given the potential impacts of the COVID-19 pandemic on staffing, we conducted a secondary analysis that excluded staffing-related domains of readiness.

Between 2013 and 2021, the proportion of children with timely access to a high readiness ED decreased from 70.2% to 66.7%, representing 2.1 million fewer children. However, many states and regions experienced improvements in access exceeding 10 percentage points. When excluding domains of readiness related to staffing, access to EDs with high equipment- and process-related readiness increased from 75.8% to 79.5%.

Pediatric access to high readiness EDs modestly declined over time, but some areas saw meaningful improvements. Excluding staffing-related readiness, which may have been affected by the COVID-19 pandemic, an increase in access was observed. Future work should examine regions with improved access to identify strategies for further improving pediatric emergency care.