Inability to find Pediatric (and ICU) landing spots

[Janders]

Those of you that work in community hospitals surely know the pain of making dozens of calls, begging transfer coordinators to accept your dying tertiary/specialty patients who are lingering in your overly full community EDs for hours (days…).

Which explains why I got 4 different texts today asking if I was the author of the above mentioned text.

No, I’ll have you know my text-rants are fine works of literary genius, mixing the tone of Faulkner, the ironic cynicism and obscure references of Pynchon, and the vobulary of Carlin. And I’m not the NYT source.

Which one of you is?

As Hospitals Close Children’s Units, Where Does That Leave Lachlan? (Published 2022)

Adult beds are more lucrative than children’s beds. So as institutions look to boost profit margins, pediatrics is often among the first services to be cut.

www.nytimes.com

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[turkeyjerky]

“I know you guys are exhausted at this hospital, and I get it,” she shouted, leaning over Lachlan’s bed to level her eyes with the attending physician on the other side. “But you will not send this child home so he can watch his own vitals drop.” ...Lachlan was discharged from the E.R. after 10 hours with a course of steroids to fight the inflammation in his lungs..."

They couldn't find a better case study than this? I mean, I'm probably just jaded and all, but it sounds like that mother has an anxiety disorder and the kid is overmedicalized.

 

[DrDrummer]

“I know you guys are exhausted at this hospital, and I get it,” she shouted, leaning over Lachlan’s bed to level her eyes with the attending physician on the other side. “But you will not send this child home so he can watch his own vitals drop.” ...Lachlan was discharged from the E.R. after 10 hours with a course of steroids to fight the inflammation in his lungs..."

They couldn't find a better case study than this? I mean, I'm probably just jaded and all, but it sounds like that mother has an anxiety disorder and the kid is overmedicalized.

I am pretty sure any actual ER doctor reading this had a very similar reaction.

 

[Dr Mantis Toboggan]

Those of you that work in community hospitals surely know the pain of making dozens of calls, begging transfer coordinators to accept your dying tertiary/specialty patients who are lingering in your overly full community EDs for hours (days…).

View attachment 360520
Which explains why I got 4 different texts today asking if I was the author of the above mentioned text.

No, I’ll have you know my text-rants are fine works of literary genius, mixing the tone of Faulkner, the ironic cynicism and obscure references of Pynchon, and the vobulary of Carlin. And I’m not the NYT source.

Which one of you is?

As Hospitals Close Children’s Units, Where Does That Leave Lachlan? (Published 2022)

Adult beds are more lucrative than children’s beds. So as institutions look to boost profit margins, pediatrics is often among the first services to be cut.

www.nytimes.com

I assume most of the capacity issues at my nearby children’s hospital (powerhouse facility) are due to inability to staff all the beds but having transfers turned down there sucks and I hate it.

 

[RustedFox]

P.O.W.E.R.H.O.U.S.E.

 

[CoolDoc1729]

Those of you that work in community hospitals surely know the pain of making dozens of calls, begging transfer coordinators to accept your dying tertiary/specialty patients who are lingering in your overly full community EDs for hours (days…).

View attachment 360520
Which explains why I got 4 different texts today asking if I was the author of the above mentioned text.

No, I’ll have you know my text-rants are fine works of literary genius, mixing the tone of Faulkner, the ironic cynicism and obscure references of Pynchon, and the vobulary of Carlin. And I’m not the NYT source.

Which one of you is?

As Hospitals Close Children’s Units, Where Does That Leave Lachlan? (Published 2022)

Adult beds are more lucrative than children’s beds. So as institutions look to boost profit margins, pediatrics is often among the first services to be cut.

www.nytimes.com

The capacity issues need to be in the news. People should know what is going on. It is newsworthy that the healthcare system flat out doesn’t work like it did pre covid and that the unlimited medical resources that have been present for all of our lifetimes are no longer unlimited.

Every day I spend half my shift explaining, no , today isn’t different, no, my hospital isn’t different, the healthcare system is in shambles and there is not enough of anything anywhere. Recently we had to send an aortic dissection to a different state. I’m in a pretty decent sized state with several world class medical centers. They are all always full and on divert.

I’m thankful that I have an auto accept facility for peds and I can keep most everything else, or I’d spend half my shift begging other hospitals to take my patients as I know many of you do.

But I didn’t write the text. I don’t even know who Pynchon is.

 

[BoardingDoc]

“I know you guys are exhausted at this hospital, and I get it,” she shouted, leaning over Lachlan’s bed to level her eyes with the attending physician on the other side. “But you will not send this child home so he can watch his own vitals drop.” ...Lachlan was discharged from the E.R. after 10 hours with a course of steroids to fight the inflammation in his lungs..."

They couldn't find a better case study than this? I mean, I'm probably just jaded and all, but it sounds like that mother has an anxiety disorder and the kid is overmedicalized.

I completely agree with the article's point: that there are way too few pedi beds available. I also agree that this patient is a crap example. There's a photo of the kid in the ER in the article. He's in NAD, not on Os, looks bored. The monitor behind him shows a crappy pleth but still a sat of at least 95%. This kid doesn't need to be admitted. His mother's misplaced anguish over the fact that he isn't being admitted isn't a result of the lack of pedi beds, it's a contributing cause of it.

 

[hundreddaysoff]

Not in Boston. Even if I were, I wouldn't write a text like that and certainly would never leak it to the media. Because I know it wouldn't change anything and might even backfire in ways I'm not smart enough to predict.

 

[Apollyon]

I don’t even know who Pynchon is.

Thomas Pynchon is now an old man (85), who has been notably camera-shy for most of his life. He has written some erudite (which can be a code word for "dense") books, including Gravity's Rainbow, The Crying of Lot 49, and Inherent Vice, which was made into a movie of the same name almost 10 years ago.

His avoidance of publicity has left a void that was filled with even crazier ideas of whom he might be, as time went on.

 

[Dred Pirate]

P.O.W.E.R.H.O.U.S.E.

Powerhouse Ministries Inc. - Powerhouse Hospital, Old Tafo, Kumasi, Ghana
this is the only powerhouse hospital

 

[PTPoeny]

Back to the original topic. Here is one hospital's approach to the lack of physical beds:

Over 70% of pediatric hospital beds in US full amid surge of respiratory illnesses

A surge in children's respiratory illnesses continues across the country.

abcnews.go.com

 

[RoyBasch]

Back to the original topic. Here is one hospital's approach to the lack of physical beds:

Over 70% of pediatric hospital beds in US full amid surge of respiratory illnesses

A surge in children's respiratory illnesses continues across the country.

abcnews.go.com

Problem is in most cases, the issue is not physical space for patients but staff to take care of them. I remember during various covid waves a lot of my non medical friends would ask me about hospital over crowding and ask me why we didn't just set up tents, beds in the parking garage, etc. (We did do many of these things at any rate), but the issue was ultimately more staffing. Just putting a patient on a bunch of drips and a vent in the parking garage doesn't do much good if you don't have an available nurses and RTs to monitor the patient and execute the orders.

 

[benem]

The original article is deeply flawed in that it doesn’t recognize that the acuity of pediatric inpatient care in most community hospitals is or was incredibly low. There are lots of community hospitals with less than 10% occupancy rates on their pediatric units and no dedicated full time staff for pediatric units. Essentially these units serve as obs units for pediatric patients that come through the ED. These units are unable to care for critically ill children and have none of the dedicated resources of a children’s hospital. It is true that kids generally don’t make as much money for hospitals, largely due to the fact that a higher percentage of them are on Medicaid, but realistically these units were largely empty anyway. We have such a problem with healthcare reporting in this country, so many reporters have no understanding of the healthcare system.

 

[PTPoeny]

Somehow all of the sudden in the last two weeks at my hospital we have been able to staff every physical bed and then ran out of physical beds... I don't understand since before two weeks ago we were closing for staffing at around 2/3 of the physical beds 🤷

 

[BigRedBeta]

As a pediatric intensivist, it's been a constant state of crisis bed management going on for 4+ months. Started out as lack of nursing staff and closed beds, but have been fully staffed for the last 2 months with all of our beds open. I'm in a very large (50+ beds) unit, and if I am able to keep a bed unfilled for more than 2 hours, it stands out as a very odd day. Non-urgent surgeries are subject to administration approval each day, we're still cancelling some OR's at least once a week, and boarding ICU patients in the ED for 6+ hours most days (yes I know this is normal in adults, it's not in most children's hospitals). My unit is routinely flipping 15-20% of our beds daily so it's not like we're stuck with a bunch of rocks either. For us, our system needs more ICU beds, and this sort of bed management situation was not uncommon pre-pandemic during the first wave of RSV/flu each fall. But the ongoing issues overrunning the summer months is absolutely unheard of.