Over the past year, we have published articles pointing out the decline in admissions for common pediatric illnesses that normally require an inpatient stay. This decline is most likely due to the mitigation steps we have taken to prevent the spread of COVID-19, and with it, many other common infectious and non-infectious (e.g., non-accidental trauma) conditions have been reduced. However, based on an article being released this month in our journal by Cushing et al (10.1542/peds. 2020-041723), the decline in pediatric admissions predates the pandemic and has been ongoing for at least the past decade.
This report is based on the American Hospital Association Study, which includes more than 4,700 hospitals from 2008 to 2018. During this time, the authors note a 19.1% decline of pediatric inpatient units and an 11.8% drop in numbers of beds filled on these units. In addition, rural areas had the biggest decline and almost one quarter of children in this country now face longer distances to travel to gain access to a pediatric inpatient unit. Interestingly, the number of pediatric intensive care beds increased by 16% at children’s hospitals while inpatient unit numbers decreased.
So why is this happening? Could it be that parents want to go directly to a children’s hospital rather than stop at the hospital closest to them for disorders those hospitals should be able to handle? Could it be that the hospitals themselves are encouraging families not to use the closest facility because of lack of back-up care with a PICU? Could it be that children are healthier and don’t need as many beds as they used to with the preventive therapies for asthma diabetes care, and other chronic conditions that currently exist?
While Cushing et al provide some interesting discussion as to the why this decline might be happening, we invited Drs. Jeffrey Riese and Brian Alverson from Brown to weigh in with an accompanying commentary (10.1542/peds. 2021-050432). They note the importance of the declining trends in regionalizing pediatric care and increasing trends of PICU and accompanying inpatient admissions in designated “children’s hospitals”. Rather than just celebrate the need that children’s hospitals play a critical role and should be where inpatient children can get the best care, they point out all the risks that could result if these trends continue—overcrowding of children’s hospitals, children arriving sicker because they waited longer to travel greater distances with their illnesses increasing health care costs, and other concerning implications of the trends noted in the Cushing et al study. They also note that the Cushing et al study does not compare outcomes of local community versus children’s hospitals.
Link to the study and commentary and see what you think. Then check out the inpatient data for your closest hospital for pediatric inpatients and see if it parallels the findings in the Cushing study. Share with us via a comment on our website, this blog, or our social media sites (Facebook, Twitter, or Instagram) what you find.
