Editor’s Note: Dr. Thomas Day (he/him) will be completing his pediatric residency at the Boston Combined Residency Program at Boston Children’s Hospital and Boston Medical Center and starting his fellowship in pediatric cardiology at Boston Children’s Hospital this summer.
The winter of 2022 was defined by throngs of coughing children packed into overflowing emergency department waiting rooms. Hours-long wait times and exhausted clinicians became the new normal, thanks to simultaneous surges of COVID-19, flu, and respiratory syncytial virus (RSV).
After years of consolidating and reducing pediatric capacity, the “tripledemic” of 2022 stretched the pediatric healthcare system to its limit. Despite extensive news reporting about the strain this placed on children’s hospitals, little is known about actual utilization of healthcare resources during this time.
In an article entitled “Children's Hospital Resource Utilization During the 2022 Viral Respiratory Surge,” which is being early released in Pediatrics this week, Dr. Kenneth Michelson and colleagues from Lurie Children’s Hospital, Seattle Children’s Hospital, Boston Children’s Hospital, Children’s Mercy-Kansas City, and the Children’s Hospital Association answered this question by performing a retrospective, serial, cross-sectional analysis of healthcare utilization in 38 children’s hospitals across the United States. (10.1542/peds.2024-065974)
The authors used clinical and billing data from the Pediatric Health Information System to compare peak volumes of healthcare utilization and duration of the 2022 viral respiratory season with the 2018, 2019, and 2020 seasons. They hypothesized that the 2022 viral season would have both higher peak volumes and longer durations than the preceding ones.
Surprisingly, the results were mixed. Overall peak emergency department (ED), inpatient, and intensive care unit (ICU) volumes were not elevated in 2022, compared with the highest volumes of pre-pandemic viral seasons. In fact, overall peak ED and ICU volumes were slightly lower in 2022 compared with their pre-pandemic peaks. However, nearly half (18/38) of the hospitals did have their highest ED and inpatient volumes in 2022, suggesting that hospitals faced different levels of demand.
The authors also tracked surgical volume as a balancing measure, since many hospitals delayed elective surgeries to reduce inpatient demand. Even though overall peak volumes were not elevated, they did find that overall elective surgical volumes decreased in 2022, indicating that hospitals were reducing inpatient demand in the face of the surge. Finally, they found that the 2022 viral season lasted significantly longer than pre-pandemic viral seasons.
If the overall peak volumes were not elevated, why did the healthcare system feel so overwhelmed in 2022? The authors offer several suggestions. First, the pediatric healthcare system has been reducing its capacity over the past 20 years as children have required fewer hospitalizations. COVID-19 accelerated this process as general hospitals shifted beds from pediatric to adult care. Simultaneously, the pediatric workforce has been constricting, which placed a greater burden of care on individual clinicians. Furthermore, the longer viral season meant that hospital systems and clinicians had to sustain these heightened demands for an additional month. Finally, the authors posit that the peak volumes may have peaked because the hospitals were at maximal capacity and could not expand any further. This would suggest that there may have been spillover effects on general hospitals that fall outside the scope of this dataset.
This study is a fascinating read for everybody who cared for the deluge of children in the 2022 tripledemic. It offers important insights into surge capacity planning for the pediatric healthcare system, especially as pediatric care continues to consolidate.