Children’s hospitals face ‘crisis’ bed shortage as respiratory illness surges in kids
Faced with several health crises, Triangle pediatric hospitals are struggling to meet demand for inpatient and intensive care unit beds.
Doctors say they’ve already had to delay elective procedures and reject patient transfers from smaller community hospitals as a result.
An unprecedented surge in respiratory disease coupled with an ongoing mental health crisis has filled their units to capacity, administrators at Duke, UNC and WakeMed said.
They worry the situation will worsen as the height of flu and COVID-19 season approaches.
“We’re really at a crisis situation,” said Dr. Stephanie Davis, who heads UNC’s children’s hospital. “Frankly, I’m concerned because we’re not even in the winter season yet.”
Simultaneous crises
The bed crisis started last month, when a slew of young children showed up at emergency rooms with respiratory illnesses, like RSV and influenza.
In the past several years, WakeMed’s laboratory reported fewer than 100 RSV cases a week— even during the worst surges. This season, the laboratory has routinely identified more than 170 cases a week.
RSV typically causes cold-like symptoms but can be dangerous for infants and young children, said Jessica Dixon, a WakeMed infection prevention specialist. Doctors across the country have reported an unusually busy RSV season.
Infectious disease experts don’t yet know why the virus has caused so many hospitalizations this year, though Dixon speculates that immunity against viruses that kids would usually encounter waned during the pandemic while they were isolating and wearing masks.
Doctors are simultaneously treating an uptick in young flu patients, which is likely just the beginning of a tough season.
The Southern Hemisphere’s influenza strain, which is often the same strain that later hits the U.S., caused one of the worst flu seasons in recent years, particularly for young children.
Dr. Sameer Kamath, a Duke pediatric critical care medicine specialist, said his department has had to make difficult decisions about which children to admit to a coveted hospital bed and which children to leave waiting in the emergency room.
“We’ve been in constant triage mode,” he said. “We’ve had to decide who will most benefit from the care that we have.”
Pediatric units had already been handling a surge in children who needed mental health treatment. Children admitted for self-harm injuries or other severe mental health crises often wait in emergency rooms for days or weeks before a spot in a psychiatric facility opens up.
While demand for pediatric care has skyrocketed, the number of hospital beds for kids has slowly dwindled. Between 2008 and 2018, children’s inpatient units decreased almost 20% in the United States, according to the most recent data from the American Hospital Association.
Across the country, hospitals have shut down kids beds to make room for more lucrative adult beds, The New York Times reported this month.
UNC Rex Hospital closed its pediatric unit — which housed 10 beds — at the end of August to make room for more adult patients.
“It’s just sort of the perfect storm for us,” Davis said. “We’ve never had capacity issues like this before.”
No end in sight
North Carolina hospitals are running out of room for sick kids.
Levine Children’s Hospital in Charlotte, which is currently treating more patients than it has beds, was forced to transfer a patient out-of-state this week after hitting capacity.
“Every pediatric bed in North Carolina is full today,” said Dr. Stacy Nicholson, chair of pediatrics at Levine. “This has been going on for about a week now and there is probably no end in sight.”
Children who would ordinarily be admitted to a large children’s hospital from a community hospital — some of which have no pediatric beds at all — are getting turned away.
Davis said their department has been closed to outside transfers nearly every day because their beds are full. Kamath said in recent weeks he has coached doctors at community hospitals how to care for the pediatric patients that Duke doesn’t have room to accept.
“The fear we have is not being able to help the child because of a lack of resources and then something bad happens,” he said.
This story was originally published October 20, 2022 at 10:27 AM with the headline "Children’s hospitals face ‘crisis’ bed shortage as respiratory illness surges in kids."
