Over the past decade, we have seen almost a 20% decrease in the number pediatric inpatient units in the US, and an 11.8% decrease in inpatient beds. The loss of inpatient pediatric units has increased the distance a child living in a rural area may need to travel for intensive care by as much as 50 miles. The US Health and Human Services Administration for Strategic Preparedness and Response has called for health systems to have a 20% increase in surge capacity, meaning an ability to care for a greater number of children in the setting of a major disaster or public health emergency. How well are we meeting this goal?
To answer that question, Li et al (10.1542/peds.2022-059459) from Boston Children’s Hospital and Harvard Medical School share with us a Massachusetts assessment in an article being early-released this week in Pediatrics. In a study of 58 of the 64 acute care hospitals in Massachusetts in 2021, before the recent viral surge, the authors found that a less than 2% increase in bed capacity relative to baseline were a disaster or surge situation to occur, mainly due to the lack of capacity in adult hospitals for pediatric patients. They noted a shortage of respiratory therapy capability as well as a lack of sufficient pediatric surgical expertise, and that rural areas were most disadvantaged in a surge situation.
What can we do about this? We invited a commentary from pediatric emergency medicine specialists Drs. Cullen Clark and Julie Leonard from Nationwide Children’s Hospital (10.1542/peds.2022-060099). Drs. Clark and Leonard note the importance of the Li et al, study in recognizing not only the lack of adequate capacity to accommodate a surge in admissions, but also a capability problem—meaning the inability to offer sufficient subspecialty care and supplies even if the beds existed. Drs. Clark and Leonard along with Li et al point out that the method used for this study could be adapted for other states to help inform surge planning. If your community had difficulty handling the volumes of inpatient admissions we experienced during the recent viral surge, then please take the time to read this important study and commentary, so you can be improving your disaster preparedness and in turn ensure that all children who need acute care in your region will have access to it.
