Children's hospitals not equipped to handle pandemics

[tetano]

AURORA, Colo. (Aug. 23, 2011) ? A new study of children's hospitals nationwide has found them underequipped to handle a major surge of patients in the event of a pandemic, and urges health care institutions and government agencies to immediately review emergency preparedness plans as flu season approaches.

"Every year we get lucky," said the study's lead author, Marion Sills, MD, MPH, and associate professor of pediatrics at the University of Colorado School of Medicine. "But it wouldn't take much of an epidemic to put us over capacity. If that happens where do the children go?"

The study, published in the Centers for Disease Control and Prevention's Emerging Infectious Diseases journal, examined data from 34 children's hospitals as they dealt with the 2009 H1N1 pandemic, which disproportionately affected children.

Researchers found the median occupancy rate in the hospitals was 95 percent during the H1N1 pandemic but this situation did not differ from typical levels of high occupancy commonly experienced. In the 2008-09 flu season, the median occupancy was 101 percent. Fortunately, the pandemic turned out to be milder than expected. Still, the study said, it would have only taken about 0.2 admissions per 10 beds per day to reach 100 percent occupancy across all hospitals in the study.

"Models representing an outbreak of a more virulent influenza virus based on historical comparisons demonstrate that modest increases in emergency department visits or emergency department admissions rates would have resulted in substantial overcrowding among the large cohort of children's hospitals in our study," Sills wrote.

According to Sills, pandemics last for weeks or months and affect large geographical areas, often multiple nations or continents. And even if children's hospitals could handle such occupancy rates on a short-term basis, there are real questions of whether they could do so for a prolonged period.

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 found serious deficiencies in the state of disaster/pandemic preparedness for children and 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.

She noted that while it might make financial sense to keep the hospitals 95 or 100 percent full, it might not make sense from a health care quality perspective.

"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."

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Faculty at the University of Colorado School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at University of Colorado Hospital, The Children's Hospital Colorado, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. Degrees offered by the UC Denver School of Medicine include doctor of medicine, doctor of physical therapy, and masters of physician assistant studies. The School is located on the University of Colorado's Anschutz Medical Campus, one of four campuses in the University of Colorado system. For additional news and information, please visit the UC Denver newsroom online.

http://www.eurekalert.org/pub_releases/2011-08/uocd-chn082311.php

 

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Re: Children's hospitals not equipped to handle pandemics

Inpatient Capacity at Children's Hospitals During Pandemic (H1N1) 2009 Outbreak, United States

Marion R. Sills, MD, MPH; Matthew Hall, PhD; Evan S. Fieldston, MD, MBA, MSHP; Paul D. Hain, MD; Harold K. Simon, MD, MBA; Thomas V. Brogan, MD; Daniel B. Fagbuyi, MD; Michael B. Mundorff, MBA, MHSA; Samir S. Shah, MD, MSCE

Authors and Disclosures

CME Released: 08/23/2011; Valid for credit through 08/23/2012


Abstract

Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008?09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.
Introduction

During March and April 2009, a novel influenza A (H1N1) virus began to spread in North America that disproportionately affected children, who constituted half of patients hospitalized for influenza-related illness (IRI) during spring 2009.[1?3] After a summertime decline, the virus returned to full activity in the fall, and children continued to have the highest rates of illness and hospitalization.[4] As a result, pediatric providers and children's hospitals cared for large numbers of patients with pandemic (H1N1) 2009 virus.[5,6] Despite the high attack rate for children, the pandemic virus was milder than prior pandemic viruses. The attack rate for pandemic (H1N1) 2009 was lower for children (17.9%)[7] than it was for each of the past 3 pandemics in the United States (1918, 1958, and 1968) (21%?54%),[8] and the hospitalization rate was lower for children by >48-fold (0.17/1,000 symptomatic children[9] vs. estimates as high as 8.5/1,000 symptomatic children[10]).

Because of relatively low virulence, pandemic (H1N1) 2009 resulted in comparatively fewer hospitalizations than feared, but it greatly affected ambulatory settings and emergency departments (EDs).[11?13] The exact effect on children's hospitals remains unknown because published studies have reported only regional data and have quantified hospital admissions rather than inpatient occupancy.[14?16] Assessing use of capacity in the context of a low-virulence influenza pandemic can provide insight into how a more virulent virus might directly affect children's hospitals and indirectly affect all health care systems throughout their catchment areas. Occupancy levels above and beyond existing capacity limits would represent a true crisis that would dramatically affect the already-stretched health care?delivery system.[17] Because children's hospitals play an integral role in coordinating health delivery,[18] defining the limits of capacity reserve and quantifying how close these hospitals came to exhausting these limits can help the entire health care system better plan for more virulent pandemics or other disaster-type events.

With the effect of pandemic (H1N1) 2009 on children's hospitals as a collective case study, we evaluated how close to full capacity US children's hospitals functioned during the outbreak of pandemic (H1N1) 2009 and the implications for the health care systems had we not been fortunate regarding the low virulence of subtype H1N1 influenza.[19] The objectives of this study were to 1) compare occupancy at US tertiary care children's hospitals during the pandemic period with occupancy during the 2008?09 seasonal influenza outbreak, 2) measure how close each hospital came to exhausting capacity for inpatient beds, and 3) measure the effect on capacity if pandemic (H1N1) 2009 during fall 2009 had been more severe.

http://www.medscape.org/viewarticle/748148

 

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Re: Children's hospitals not equipped to handle pandemics

http://www.cdc.gov/eid/content/17/9/101950.htm


EID Journal Home > Volume 17, Number 9?September 2011
Volume 17, Number 9?September 2011
Research
Inpatient Capacity at Children's Hospitals during Pandemic (H1N1) 2009 Outbreak, United States

Marion R. Sills, Comments to Author Matthew Hall, Evan S. Fieldston, Paul D. Hain, Harold K. Simon, Thomas V. Brogan, Daniel B. Fagbuyi, Michael B. Mundorff, and Samir S. Shah
Author affiliations: University of Colorado School of Medicine, Aurora, Colorado, USA (M.R. Sills); Children's Hospital Colorado, Aurora (M.R. Sills); Child Health Corporation of America, Shawnee Mission, Kansas, USA (M. Hall); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA (E.S. Fieldston, S.S. Shah); Children's Hospital of Philadelphia, Philadelphia (E.S. Fieldston, S.S. Shah); Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA (P.D. Hain); Emory University School of Medicine, Atlanta, Georgia, USA (H.K. Simon); Children's Healthcare of Atlanta, Atlanta (H.K. Simon); Seattle Children's Hospital, Seattle, Washington, USA (T.V. Brogan); University of Washington School of Medicine, Seattle (T.V. Brogan); The George Washington University School of Medicine, Washington, DC, USA (D.B. Fagbuyi); Children's National Medical Center, Washington (D.B. Fagbuyi); and Intermountain Healthcare, Salt Lake City, Utah, USA (M.B. Mundorff)

Abstract
Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008?09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity...