This fall’s severe shortage of pediatric hospital beds is a consequence of financial decisions made by hospitals over the past decade, when they closed children’s wards, which frequently operate in the red, and increased the number of beds available for more profitable endeavors, such as joint replacements and cancer care.
Nationally, medical centers have established triage tents, postponed elective procedures, and transported seriously ill children out of state to deal with the influx of young patients infected by a confluence of virulent viruses, particularly respiratory syncytial virus, influenza, and coronavirus.
Mark Wietecha, chief executive officer of the Children’s Hospital Association, cited a decades-long trend among hospitals to eliminate pediatric units, which are typically less profitable than adult units, as a primary cause of the bed shortfall. Hospitals maximize income by aiming to keep all of their beds occupied with patients suffering from diseases that elicit large insurance payouts.
Dr. Scott Krugman, vice chair of pediatrics at the Herman and Walter Samuelson Children’s Hospital at Sinai in Baltimore, stated, “It all comes down to money.” There is little motivation for hospitals to perform money-losing services. “Hospitals rely on high-volume, high-reimbursement procedures from good payers to make money.”
From 2008 to 2018, the number of pediatric inpatient units in hospitals decreased by 19%, according to a study published in Pediatrics in 2021. This year alone, hospitals in Boston, Massachusetts; Springfield, Massachusetts; Richmond, Virginia; and Tulsa, Oklahoma have closed their pediatric units.
The rising increase of serious respiratory diseases among youngsters is another illustration of how covid-19 has destabilized the health care system. The lockdowns and isolation that characterized the early years of the pandemic left children mostly unexposed — and susceptible — to viruses other than covid for two winters, and doctors are now essentially treating respiratory problems from multiple years.
The pandemic has also expedited changes in the health care system that have left many areas with fewer hospital beds and fewer doctors and nurses to care for seriously unwell children.
In 2020, when intensive care units were overrun with elderly covid patients, some hospitals began to use children’s beds to treat adults. Dr. Daniel Rauch, chair of the hospital care committee of the American Academy of Pediatrics, stated that many of these pediatric beds have not been reinstated.
In addition, the relentless speed of the pandemic has prompted almost 230,000 doctors, nurses, and physician assistants to quit. Wietecha stated that before the epidemic, approximately 10% of nurses quit their positions annually, but that number has since increased to 20%. According to his estimation, pediatric hospitals are unable to sustain up to 10 percent of their beds due to personnel shortages.
Dr. Megan Ranney, who works in multiple emergency rooms in Providence, Rhode Island, including Hasbro Children’s Hospital, stated, “There is simply not enough capacity for all the children who require beds.” The number of children needing emergency care at the hospital has increased by 25 percent in recent weeks.
The vice dean of Brown University’s School of Public Health, Ranney, stated, “We have doctors cleaning beds so that we can get children into them faster.”
Doctors are concerned about a “triple epidemic” of respiratory illness 02:52
There is hardly much profit to be made from treating children. Medicaid, a combined federal-state program for low-income patients and persons with disabilities, covers about 40% of U.S. youngsters. Medicaid base rates are often more than 20% less than those paid by Medicare, the government insurance program for older persons, and even less than private insurance. While speciality care for a variety of frequent adult procedures, such as knee and hip replacements, heart surgeries, and cancer treatments, generates substantial revenues for medical facilities, inpatient pediatric care often results in a loss for hospitals.
When Tufts Children’s Hospital closed 41 pediatric beds last summer, hospital administrators assured locals that nearby Boston Children’s Hospital could provide treatment for young children. Now, Boston Children’s is postponing certain elective surgery to create way for children with life-threatening conditions.
Rauch remarked that children’s hospitals, which specialize in treating unusual and severe illnesses such as pediatric cancer, cystic fibrosis, and heart defects, are not equipped to handle this season’s influx of youngsters with severe respiratory infections.
Even before the fall’s viral triumvirate, pediatric departments were struggling to accommodate an increasing number of adolescents in significant mental distress. There are several accounts of children in mental crisis being stranded in emergency departments for weeks before being transferred to a pediatric psychiatric ward. On a good day, 20% of pediatric emergency room beds at Hasbro Youngsters’s Hospital are occupied by children with mental health problems, according to Ranney.
In an effort to increase pediatric capacity, the American Academy of Pediatrics and the Children’s Hospital Association petitioned the White House last month to declare a national emergency due to child respiratory infections and grant additional funding to help cover the expenses of care. The latitude afforded hospital systems and providers during the pandemic to circumvent certain staffing rules also extends to RSV and influenza, according to the Biden administration.
Doernbecher Children’s Hospital at Oregon Health & Science University has adopted “crisis standards of care,” allowing intensive care nurses to treat more children than is customary. In the meantime, hospitals under Atlanta, Pittsburgh, and Aurora, Colorado have resorted to treating young patients in parking lot tents.
Dr. Alex Kon, a pediatric critical care physician at Community Medical Center in Missoula, Montana, stated that arrangements have been made to care for older children in the adult intensive care unit and to divert ambulances as necessary. With only three pediatric intensive care units in the state, young children may be airlifted to Seattle, Spokane, or Idaho.
At the Community Medical Center in Missoula, Montana, a little infant with RSV is being treated. Community Health Services
Last month, Hollis Lillard brought her 1-year-old son, Calder, to an Army hospital in Northern Virginia after he suffered from fever, coughing, and hard breathing for several days. They endured seven agonizing hours in the emergency room before being evacuated by ambulance to the Walter Reed National Military Medical Center in Maryland, when a bed became available.
Calder’s illness was easily treatable with the right treatment and guidelines for home care: he recovered after receiving oxygen and treatment with steroids, which combat inflammation, and albuterol, which prevents bronchospasms. He was released the following day.
Although hospitalizations for RSV are decreasing, rates remain far above seasonal norms. And hospitals may receive little relief.
Multiple infections with RSV are possible per year, and Krugman is concerned about a comeback in the coming months. Due to the coronavirus, which competes with other viruses, “the typical seasonal pattern of viruses has disappeared,” he noted.
Like RSV, the influenza season began early this year. Typically, both viruses peak around January. According to the Centers for Disease Control and Prevention, three flu strains have caused an estimated 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths.
Krugman is skeptical that the health care business will quickly learn from the current crisis. Krugman stated, “Unless there is a major shift in how we pay for pediatric hospital care, the bed crisis will only worsen.”
KHN (Kaiser Health News) is a national news organization that delivers in-depth health-related journalism. KHN, with Policy Analysis and Polling, is one of KFF’s three primary running programs (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on national health issues.
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