'Our March 2020': Capacity crisis, labor shortages collide at children's hospitals

Labor shortages are complicating children's hospitals' ability to address severe capacity issues amid a significant surge in patients with respiratory syncytial virus. The situation mirrors the challenges adult acute care hospitals saw with COVID-19 in 2020, with some pediatric facilities delaying elective surgeries to free up resources and capacity. 

Hospitals typically see a jump in RSV cases in late winter. This year, cases began appearing in late August and have steadily risen since, creating capacity issues at children's hospitals across the country. In October, some hospitals reported case increases of 300 percent or more compared to the previous month.

The unrelenting rise in cases spurred California's Orange County to declare a state of emergency Oct. 31. The declaration allows county officials to require hospitals that do not typically treat children "to care for them if and when we need it," County Health Officer Regina Chinsio-Kwong, DO, told the Los Angeles Times.

Many hospitals are responding to the capacity crisis with inadequate staffing due to ongoing labor challenges. UVA Health's pediatric intensive care unit is operating with about two-thirds of necessary staff members, Stacy Williams, RN, a PICU nurse at the Charlottesville, Va.-based health system, told The Atlantic in an Oct. 31 report. 

Hospitals are looking internally and externally for staffing support, but the specialty knowledge needed to treat pediatric patients complicates these efforts.

"You can't just train a bunch of people quickly to take care of a 2-month-old," Sapna Kudchadkar, MD, PhD, a pediatric-intensive-care specialist and anesthesiologist at Baltimore-based Johns Hopkins Medicine, told the publication. 

Johns Hopkins Children's Center in Baltimore is deploying nurses to the pediatric emergency department from other areas of the hospital and will soon have adult physicians care for pediatric patients, according to The New York Times.

"It all has a very Covid-esque feel to it," Meghan Bernier, MD, PICU medical director at Johns Hopkins Children's Center, told the Times. "This is the pediatrician's Covid. This is our March 2020."

Other hospitals are housing two patients to a room, diverting pediatric patients to other units or tapping specialists from other departments to stabilize children waiting for an ICU bed. Boston Children's Hospital has postponed some elective surgeries to increase capacity for RSV patients, according to the Times. Oklahoma Children's Hospital in Oklahoma City is also considering delaying electives, Cameron Mantor, MD, the hospital's chief medical officer, told ABC affiliate KOCO.

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