Issue: October 2011
October 01, 2011
2 min read

Children’s hospitals appear unprepared to handle pandemic

Sills MR. Emerg Infect Dis. 2011;doi:10.3201/eid1709.101950.

Issue: October 2011
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Children’s hospitals appear to be underequipped to handle a pandemic, and health care institutions and government agencies should re-assess current emergency preparedness plans, according to findings of a recent study.

“Every year we get lucky,” Marion Sills, MD, MPH, associate professor of pediatrics at the University of Colorado School of Medicine and study researcher, said in a press release. “But it wouldn’t take much of an epidemic to put us over capacity. If that happens, where do the children go?”

The study examined data from 34 children’s hospitals and how they handled the 2009 H1N1 pandemic, which disproportionately affected children. The researchers said the median occupancy rate in the hospitals was 95% during the H1N1 influenza pandemic, but this situation did not differ from typical levels of high occupancy commonly experienced. In the 2008-2009 influenza season, the median occupancy was 101%. Although the pandemic resulted in milder than anticipated illness, the study researchers said a more severe pandemic would have a profound effect on basic services.

“It would have only taken about 0.2 admissions per 10 beds per day to reach 100% occupancy across all hospitals in the study,” the researchers wrote.

“H1NI was not as virulent as people had feared, but the next one might be,” Sills said. “The point of this paper is that it wouldn’t take a much more virulent virus to get us into serious trouble.”

Pandemics last for weeks or months and affect large geographical areas. Even if children’s hospitals could handle such occupancy rates on a short-term basis, questions remain about whether they could do so for a prolonged period, according to Sills.

The findings are especially significant in the context of national disaster planning related to children. The National Commission on Children and Disasters: 2010 Report to the President and Congress reported serious deficits regarding disaster/pandemic preparedness for children. The report recommended the creation of a regionalized pediatric care system to help rectify these deficiencies.

“Our study shows that children’s hospitals, the central component of this proposed regionalized system, routinely operate so closely to capacity that little available reserve exists for even a modest surge of inpatients,” Sills said in the release.

The study findings revealed that for a hospital with 150 non-ICU beds and 50 ICU beds, an additional three non-ICU and 3.5 ICU admissions per day would have exhausted capacity.

Sills said although it may make financial sense to keep the hospitals 95% or 100% full, it may not make sense from a health care quality perspective.

Disclosures: Dr. Sills received grants for clinical research from the Agency for Healthcare Research and Quality. Dr. Simon received grants for clinical research from Baxter International (rehydration clinical trial); AspenBio Pharma (appendicitis screening); NIH (progesterone planning trial through the Pediatric Applied Research Network), all through Emory University. Dr. Fagbuyi owns stock, stock options or bonds from Medco Health Solutions; Orexigen Therapeutics. Dr. Shah received grants for clinical research from NIH; Agency for Healthcare Research and Quality; Robert Wood Johnson Foundation. Drs. Hall, Fieldston, Hain, Brogan and Mundorff report no relevant financial disclosures.

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