In addition to rising COVID-19 cases and a mental health epidemic, children’s hospitals are being pushed to the brink of collapse as they face a surge in respiratory outbreaks. This is a multifaceted threat that could recur without a policy fix.
Children’s Hospital survived the worst of the pandemic because pediatric COVID-19 case numbers are low relative to adults. But diagnoses of COVID-19 and RSV among children have risen in recent months. Those patients are going to hospitals whose capacity is already stretched by a surge in children and young adults with behavioral health problems.
“Pediatric hospitals are in crisis mode right now,” said Lisa O Connor, Senior Managing Director, FTI Consulting. “They’re pulling out emergency preparedness policy and activating everything they can from a policy and regulatory standpoint.”
Policy experts say healthcare providers and governments should invest in pediatric care and
“It’s a perfect storm,” said Dr. Daniel Rauch, professor of pediatrics at Tufts University and chair of the American Academy of Pediatrics Hospital Nursing Committee. “Most small and safety net hospitals can’t afford to keep their pediatric beds open if they’re breaking even on Medicaid at best.”
So, for resources For fewer units, viral outbreaks can be overwhelming. For example, Orange County, California, declared a health emergency this week as health care providers there battle COVID-19, RSV and the flu.
Meanwhile, the hospital is still struggling to recruit staff. During the COVID-19 pandemic, health systems have trained lower-level practitioners to treat less severe patients, but this approach is not feasible for most pediatric care because it is too specialized.
“Despite Carrie Kroll, vice president of advocacy, public policy and political strategy for the Texas Hospital Association: weathering the ‘perfect storm’
RSV surge earlier than expected this year, forcing hospitals to adjust operations to accommodate influx of pediatric patients.
In California, RSV rates are rising significantly in the Santa Barbara area. Cases doubled three weeks ago and have doubled since then, said Dr. Lynn Fitzgibbons, an infectious disease physician at Santa Barbara Cottage Hospital. , with as many RSV infections in the past week as last month.
Dr. Elizabeth Meade, Medical Director of Pediatric Quality at Providence Swedish in Seattle, said inpatient pediatric units in the region have Running at full capacity. Between 50% and 75% of Providence Swedish’s pediatric patients are being treated for RSV, which is more than the facility sees in a typical winter.
As a result, the hospital instituted A contingency plan that applies lessons learned from the pandemic. Moving staff from adult care to pediatrics is another potential solution, Mead said. The emergency department in Providence, Sweden, is evaluating how to use it in the absence of beds, she said. Where to house the kids. Sick kids.
RSV patients are grouped together in Providence Swedish, and the Pediatrics and Pediatric Intensive Care Units are on the same floor, Meade said. She said if they needed For additional space, teenage patients with non-communicable diseases, such as behavioral health issues or needing after surgery, will be moved.
North Carolina Healthcare Association has deployed a centralized link System to facilitate patient transfers before Hurricane Florence hit in 2018 and more recently during the COVID-19 surge, placing patients in harder-to-find beds such as pediatric ICUs.
Make RSV Adding to the crisis is a rising number of mental health cases among children and young adults, further exacerbating the capacity of children’s hospitals.Children with mental health problems are staying in hospital emergency rooms longer—sometimes for weeks—because Inpatient or outpatient services have been cut or facilities are full.
Limitations in mental health capacity of pediatric providers are symptoms of long-standing and often overlooked deficits. Due to low reimbursement rates, student choice Access to pediatric mental health care has historically been limited due to insufficient financial incentives for specialization and a narrow insurance network.
“Part of the solution needs to be upstream. What are we doing in prevention, and how do we ensure that children receive appropriate care in the home or outpatient setting, which is not always available? said Anne Dwyer, associate research professor at the Center for Children and Families at Georgetown University.
Policy experts and healthcare trade associations propose long-term solutions for short-term capacity building and long-term solutions for stabilizing the pediatric sector.
Centers for Medicare and Medicaid Services should codify Relaxed rules enacted during the coronavirus public health emergency to facilitate telehealth visits, such as not requiring clinicians to be licensed in the same state as patients, Rauch said.
EXTENDED PUBLIC HEALTH EMERGENCY The facility waiver would allow the conversion of hospitals not typically used for patient care H, said Bob Garrett, CEO of Edison, N.J.-based Hackensack Meridian Health. Adding more graduate medical education spots for psychology students will increase the number of specialists.
The Texas Hospital Association is working on a $65.5 million legislative proposal to increase the number of nursing students Loan repayments, funding training programs to replace retired nursing professors, and increasing nursing school capacity. Last year, Texas nursing schools rejected more than 15,000 qualified applicants for lack of resources, Kroll said.
said. “The only real way to turn things around is to get more people into the workforce.
Congress should remove the cap on graduate medical education payments to teaching hospitals, the federal government and the states Rauch said Medicaid reimbursement for pediatrics should be raised to match Medicare rates. Otherwise, more More pediatric hospital beds will disappear, he said.
From 2008 to 2018, the number of pediatric hospital beds Declined.
CMS notified state Medicaid agencies in August of the Early and Regular Screening, Diagnosis and Treatment benefit, which funds preventive pediatric mental health care. CMS Drum*) States can also receive additional funding through the American Rescue Act, which provides $12 billion for home and community-based services under the Medicaid program. Eligible states can increase Medicaid match rates for related services by 10 percentage points.
Director of Infection Prevention and Control, Lurie Children’s Hospital of Chicago.”Hospitals are businesses and hospitals need profits to stay open, so hospitals are making business decisions about how to staff those beds so they can recoup The cost of providing health care. “
Pediatrics should focus on primary care, which would reduce the burden on hospitals, said Dr. Keith Jensen, Regional Medical Director of Pediatric Emergency Medicine at Texas Women’s Hospital and HCA Houston Healthcare. High salaries in primary care would also encourage more people to choose pediatrics as a specialty, he said.