A reversal: Adult providers assist pediatric specialists amid RSV surge

Two years ago, pediatric providers found themselves taking care of adult patients, in an effort to lend a hand where they could during the first winter of the COVID-19 pandemic. Now it's the opposite: amid the ongoing respiratory syncytial virus surge, providers who don't normally care for kids are stepping in to support pediatric staff. 

"It all has a very COVID-esque feel to it," Meghan Bernier, MD, medical director of the pediatric intensive care unit at Johns Hopkins Children's Center in Baltimore, told The New York Times in a story earlier this month. "This is the pediatrician's COVID-19. This is our March 2020." 

While the CDC does not track national RSV case numbers, hospitalizations or deaths, there were more than 26,000 positive tests between Oct. 30 and Nov. 12 — far higher than over the same period last year. As of Nov. 16, 78 percent of the nation's pediatric hospital beds were full, with seven states reporting capacity levels above 90 percent, according to HHS data cited by NBC News. 

The specialty knowledge required to treat pediatric patients can complicate hospitals' efforts to find additional staffing support. 

"When I was back in med school, you learn that everyone, if you're not used to taking care of babies … can be a little nervous taking care of them," Eric Biondi, MD, head of hospital medicine at Johns Hopkins Children's Center, told Becker's during a Nov. 3 call.  

While the hospital is deploying floor nurses to the pediatric ED, it has not yet had to pull in adult physicians to treat children. If there is a need to bring in additional providers, Dr. Biondi said it's key to ensure they're supported and assisting in the right space. 

"We have to think about making sure that the workforce that we're putting out there to take care of those kids is also high-quality, and we have to be constantly assessing what that means in terms of making sure that workforce is supported, staffed appropriately and has the appropriate amount of resources," he said. 

That might mean having a pediatrician work alongside or be easily accessible to providers who don't normally care for children. Under capacity strain, pediatric-trained providers may be reserved to care for the youngest children and those with the most pediatric-specific issues. Adult providers, then, would be best suited and more comfortable taking care of adolescents. Simply put, "you wouldn't just take an adult provider who has never spent any time in a peds emergency room and stick them with the 4-day-old baby," Dr. Biondi said. 

No matter where or how assistance is needed, providers of all backgrounds have been willing to step in. 

"You are not seeing anyone saying, 'This isn't my job, this isn't my problem,' — everyone is stepping up and saying, 'What can I do? How can I help? Where do you need me today?'" Dr. Biondi said. 

COVID-19 made familiar some of the other measures children's hospitals are now taking to respond to severe capacity challenges, which include delaying emergent procedures and using overflow tents. Last week, Grand Rapids, Mich.-based DeVos Children's Hospital filed an emergency certificate of need request to add 48 additional beds as it grapples with an influx of RSV patients. 

"Hopefully we'll come out of this similar to how we came out of COVID-19, which is with newer, innovative ways of providing high-quality and efficient care, and in a better healthcare world than we had before," Dr. Biondi said. 

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