Outsourcing pediatric care to children’s hospitals could limit hospital capabilities, particularly in remote areas without a children’s hospital.
RT’s Three Key Takeaways:
- US hospitals closed nearly 30% of pediatric inpatient units and reduced pediatric beds by 19.5% between 2008 and 2022, while adult inpatient capacity saw only minimal declines.
- Financial incentives favoring adult care and staffing shortages have contributed to the reduction in pediatric inpatient capacity, leading to longer wait times and increased burden on families.
- The decline in pediatric units has forced general hospitals to transfer more children to large pediatric centers, potentially compromising access to timely care, especially during health crises like the 2022 viral “tripledemic.”
US hospitals closed a third of their pediatric inpatient units between 2008 and 2022, according to study findings published in JAMA Pediatrics.
The study analyzed de-identified medical and surgical data from the American Hospital Association annual survey. Of 2,074 hospitals that reported ever having a pediatric inpatient unit between 2008 and 2022, the researchers found that:
- The number of pediatric inpatient units declined by almost 30% (from 1,749 to 1,226 units) and pediatric beds declined by 19.5% (from 31,133 to 25,064 beds).
- Adult inpatient units only decreased by 4.4% (from 4,519 to 4318 units), and adult beds declined by 3% (from 405,908 to 393,802 beds).
“There are several potential drivers for this decrease in pediatric inpatient capacity,” said Children’s Hospital Los Angeles researcher Anna Cushing, MD, who collaborated on the study. Dr. Cushing noted that adult beds generate more revenue than pediatric beds, and staffing shortages, make it difficult to source specialized resources needed to care for children with increasingly complex medical needs.
“This could mean longer wait times at children’s hospital emergency departments as more patients are referred to them and delays in accessing definitive care for children who need to be transferred longer distances for inpatient care, increasing the cost and burden to families,” Cushing said. “Children in more remote or rural areas without a children’s hospital are particularly impacted. It is essential to strengthen our pediatric care network to ensure all children can receive timely, high-quality medical care regardless of where they live.”
The study is a follow-up to Cushing’s prior lead author publication which evaluated pediatric inpatient availability from 2008 and 2018.
“Most emergency department visits for children occur in general hospitals, which have been increasingly transferring children to large pediatric centers for inpatient care,” said Cushing, Attending Physician in Emergency and Transport Medicine. The shift in pediatric care capacity, partly due to inpatient unit closures, could affect access to care for children and impact the healthcare system’s resilience to surges in patient volume, such as we saw in the 2022 viral “tripledemic” when higher numbers of flu, RSV, and COVID-19 all coincided.”
