Children's hospitals are pressed to capacity by response to pandemic outbreaksDuring 2009, a novel influenza A (H1N1) virus began to spread in North America, with children having the highest rates of illness and hospitalization. Yet, a new study shows that children's hospitals routinely operate so close to capacity that little available reserve exists for even a modest surge of inpatients.
A team of researchers led by Marion R. Sills, M.D., M.P.H., of the University of Colorado School of Medicine, examined how close 34 children's hospitals came to exhausting capacity during the 2009 outbreak. They found that for the 11-week pandemic period during the fall of 2009, the median overall inpatient occupancy was 95 percent, but this situation did not differ from typical levels of high occupancy commonly experienced. For example, in the prior 2008-09 flu season, the median occupancy was 101 percent, and occupancy was 91 percent for the entire 2008 calendar year.
Hospital experiences varied considerably, with hospital-level median occupancy rates ranging from 57.4 percent to 128.0 percent.To reach 100 percent occupancy across all study hospitals during the pandemic period, hospitals would have needed to admit a median of 0.2 additional patients per day for non-intensive care unit beds and 0.7 per day for intensive care unit beds.
Another part of the study measured the effect on children's hospital capacity if the H1N1 outbreak during fall 2009 had been more severe. Using historical precedents, the researchers constructed five models projecting inpatient occupancy. They varied the number of emergency department (ED) visits and admission rates for influenza-related ED visits. For the worst case scenario, the median occupancy would have been 132 percent.
Although the 2009 pandemic did not exhaust hospital capacity, surge capacity is scarce, as demonstrated by the many hospitals operating at or near capacity in the EDs and inpatient areas. For hospitals and government agencies, the results of this study should prompt review of preparedness planning and reconsideration of surge capacity, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16418).
See "Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States" by Dr. Sills, Matthew Hall, Ph.D., Evan S. Fieldston, M.D., M.B.A., M.S.H.P., and others in the September 2011 Emerging Infectious Diseases 17(9), pp. 1685-1691.