Access to specialized pediatric emergency services can lead to better health outcomes for children, but this access is becoming more scarce. Of the 4,500 emergency departments in the United States, only one-third are at hospitals with substantial pediatric operations. For the remaining two-thirds, the emergency room is the only part of the hospital that treats children outside of the newborn nursery. While the staff in these emergency rooms are extremely dedicated, they often lack specialized training in treating children. Moreover, most hospitals with specialized pediatric services are in large cities, leaving rural areas and smaller cities with limited or no access. This care gap is exacerbated by hospital systems that are moving away from the business of providing definitive care for children who need hospitalization. Simply put, when children do not have specialized pediatric acute care services nearby, their health outcomes are more likely to be worse. For this message, I’m spotlighting Kenneth Michelson, MD, MPH, an attending physician in our emergency department and an investigator whose big data research is generating insights into the drivers of this progressive concentration of pediatric expertise within large cities, the effects on health outcomes of pediatric patients, and potential solutions to ensure that all children have access to pediatric emergency care. 

Determining the exact cause of so-called healthcare deserts is complicated. However, a growing body of evidence shows that one factor is having a great effect: the consolidation of hospital systems as the business of medicine is evolving. Using large national datasets, Ken's research shows that consolidation reduced the number of pediatric beds as large regional players purchased hospitals and then merged specialized pediatric care into one network institution. His research analyzes large datasets of information from hospitals in multiple states to understand shifts in the type of care administered and how those shifts affect patient outcomes. For instance, his recent study published in JAMA Pediatrics showed that emergency departments with less pediatric experience—as measured by how many children they see in a year—are more likely to have delayed diagnoses for serious conditions, thus emphasizing the need for more resources to help these emergency departments. 

Ken’s next steps are to explore novel interventions to mitigate the effects of the healthcare consolidation trend and investigate tactics to bring expertise to the communities where pediatric capacity has been lost. He believes that opportunities exist to form stronger regional partnerships that connect hospitals with significant pediatric expertise and capacity to those with less and to move toward a notion of regional acute care rather than within the walls of individual hospitals. With support from a recently received federal grant, Ken’s research will map regional hospital systems where pediatric care is shared and examine how different regions perform and how outcomes differ. These potential solutions bring hope for a more equitable distribution of pediatric care.

The research conducted by Ken and his collaborators illuminates the connection between healthcare industry changes, particularly the consolidation of hospital systems, and health outcomes of children treated in emergency departments. We’ve learned that there are opportunities to provide more specialized pediatric resources to hospitals that need them. As a premier children’s hospital and research institute, Lurie Children’s and Manne Research Institute can play a crucial role. Ken explains, “All of us in the healthcare industry owe it to children to rebuild some of the pediatric capacity that once existed in many more hospitals than it does today.” This urgent call to action emphasizes the importance of our collective efforts in addressing this issue.