How Children's Hospital Beds Factor Into COVID-19 Bed Capacity for Adults

Some 50% of children are hospitalized in adult facilities. Moving them to children's hospitals would free more beds for adult coronavirus patients, recommends the Children's Hospital Association.

With a surge of COVID-19 patients expected at the nation's hospitals, which are projected to exceed bed capacity in many locations, how do children's hospital beds factor into the equation when most hospitalizations will be adult patients?

Admitting and transferring adults to children's hospitals is not a good idea because equipment, medication calibration, training, protocols, supplies, and safety alerts are geared for much younger patients, says Mark Wietecha, MS, MBA, president and CEO of the Children’s Hospital Association, (CHA) which represents the nation's 220 children’s hospitals.

Yet children's hospitals can be part of the solution "to support our broader communities," says Wietecha. To this end, the Association has devised a plan that could free up a significant number of beds for adults because 50% of children are hospitalized in about 2,000 adult facilities, he says. By directing younger patients to hospitals solely devoted to children's care, adult facilities could increase capacity for patients with coronavirus, which disproportionately impacts the adult population, according to the Centers for Disease Control and Prevention (CDC).*

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On Tuesday, CHA issued guidelines for an initiative to address this issue, "Consolidating Pediatric Hospital Care to Increase Capacity for Adults with COVID-19," and submitted it to the Centers for Medicare & Medicaid Services (CMS) for further input and guidance. CHA has not yet received a response from CMS.

Among the ideas to consider:

• Move children out of adult hospitals: The proposal calls for "consolidating child patients by moving them from adult hospitals to children’s hospitals" to "free-up beds, staff, and equipment in those adult hospitals to care for more COVID-19 adult patients. This effort also enables children’s hospitals to continue treating vulnerable kids suffering from acute illnesses and complex medical conditions who need ongoing, specialized treatment and equipment."
   
• Direct new pediatric admissions to children's hospitals: Wietecha admits that moving patients is not ideal, and suggests that perhaps new pediatric admissions at adult hospitals should be directed to facilities devoted only to children.
   
• Expand the age range of patients admitted at children's hospitals: Wietecha says that children's hospitals could expand the age range of patients they admit to include patients in their 20s.

CHA does not have authority to enforce these recommendations, which impact thousands of hospitals who are not Association members. In addition, 70% to 80% of the nation's children's hospitals are located in large multi-hospital adult systems where those administrators would be making their own assessments about how to best allocate beds. In New York City, for example, he says all children's hospitals are part of larger hospital systems.

Because decisions about how to act will occur at the local level, CHA's CEO cannot predict exactly how many hospital beds could be freed up at adult facilities, and some of those beds are in NICUs that could not accommodate adults under any circumstances. With 50% of children's beds in 2,000 adult hospitals, "if we could even move 10% or 20% of that, that frees up a lot of capacity," Wietecha says. "It doesn't solve the problem, but it helps."

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Wietecha expects CHA membership to support this initiative as they have supported similar emergency measures in the past. In fact, the idea originated from within CHA's ranks, says Wietecha. "We looked at what was happening in Seattle, and we started to understand how other metro areas, for example, Chicago, Philadelphia, and others were starting to prepare for adult COVID surge." Adult hospitals in those areas expressed a need for more critical care beds and equipment, and children's hospitals received inquiries about accommodating adult overflow COVID-19 patients, he says.  

"It was a discussion of triage and capacity at the local level," says Wietecha. "This isn't a huge bow wave of disease overriding children; this is about adult COVID surge. That's how this began."

He acknowledges the guidelines may create hardships for parents who may have to drive further and also put pressure on hospitals to act differently.

"We very much believe that kids should be cared for at the local level, wherever possible," says Wietecha. "Generally speaking, we don't call for all kids to be consolidated at [children's] hospitals." During this "extraordinary" time, however, he says temporary changes are necessary.

"Obviously, the local level decides everything, he says. "We were pretty clear on that. And at the end of the day, if we run out of everything for everybody, of course we're going to put people wherever we can find space. That's just a national response we all have a duty to support. [With these guidelines] we're simply saying that let's start the discussion with what is the best way to safely and quickly get moving on this."

*According to the CDC's Morbidity and Mortality Weekly Report published on March 18 of 4,226 COVID-19 cases in the United States that occurred during February 12–March 16, 2020, "31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged equal to or greater than 65 years, with the highest percentage of severe outcomes among persons aged equal to or greater than 85 years."