No staffed pediatric ICU beds left in North Texas region, hospital official says

[UODOCPDX]

It seems like Delta seems to having a bigger impact on the young compared to the other Covid variants as I don’t remember pediatric ICU filling up like this last year. I have to wonder what is going to happen in states like Texas and Florida which have re opened schools but don’t have mask policies in place.

“A spike in COVID-19 cases has resulted in no pediatric ICU beds left in the North Texas region, hospital officials said Thursday.”

No staffed pediatric ICU beds left in North Texas region, hospital official says

“We [have] no staffed pediatric ICU beds available in Trauma Service Area E,” said Stephen Love, President/CEO, Dallas-Fort Worth Hospital Council.

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165 Cook Children's doctors sign letter urging North Texas schools to implement mask mandates

“Pediatric bed capacity in the North Texas region is currently running at almost 98% with 150 pediatric patients on ventilators.”

165 Cook Children's doctors sign letter urging North Texas schools to implement mask mandates

With the rise in cases and hospitalizations, 165 doctors with Cook Children’s issued a letter to local school districts urging for as many safety precautions as possible as kids return to school. That letter prompted Fort Worth ISD to change its policy and implement a mask mandate.

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[sylvanthus]

F’ing tragic, what the hell.

 

[skougess]

Correlation =\= causation. It’s just like everywhere else, COVID is probably 5% of the puzzle. The rest is nursing shortage and then RSV (which we are seeing a metric butt-ton of).

You can even see the disingenuousness in the article itself. “73 Covid patients, highest ever! Also RSV is here….oh how many are hospitalized with RSV? Some amount. Who can really say?….is that important?….LOOK OVER HERE 150 KIDS ON VENTILATORS!!”

 

[EctopicFetus]

No nurses. That’s the problem. Hospitals won’t pay Thats the story. That’s the problem. Nationally 1900 kids hospitalized with Covid. Vanderbilt had 12 Covid patients hospitalized. That sucks but thats not overwhelming anything. Lack of staff is the problem. The market shifted and hospitals are slow to catch up.

 

[DeadCactus]

Disingenuous is discounting the impact of having 5-40% of your bed capacity taken up by extra patients in a pandemic and then trying to divert attention to a nursing shortage while ignoring the impact that pandemic had on contributing to that shortage via burn-out and travel nurse wages. And that's given the benefit of the doubt and running with the theory that there actually is enough of a pediatric nursing shortage to be the bottleneck. There are about 6,000 PICU beds in the US and most are run on a tight margin, it doesn't take much to start straining resources.

 

[RustedFox]

I'll play.

Pandemic is gonna pandemic. That's not gonna change.
Maybe... just maybe... hospital systems wouldn't encounter such shortage problems if they had a plan in place to expand surge capacity and be proactive instead of reactive;

and

hospital systems wouldn't encounter such shortage problems during non-pandemics if they would treat their employees right so as not to piss them all off and drive them away.

Somehow, I don't see this as the shortcoming of the nurses and techs out there. Want loyal employees? Treat them right. Give them a reason to be invested in the healthcare system. Same with physicians.

 

[skougess]

Disingenuous is discounting the impact of having 5-40% of your bed capacity taken up by extra patients in a pandemic and then trying to divert attention to a nursing shortage while ignoring the impact that pandemic had on contributing to that shortage via burn-out and travel nurse wages. And that's given the benefit of the doubt and running with the theory that there actually is enough of a pediatric nursing shortage to be the bottleneck. There are about 6,000 PICU beds in the US and most are run on a tight margin, it doesn't take much to start straining resources.

Am I crazy or was everyone’s ED still a boarding mega-parking-lot 2 months ago during the COVID low? Was it still COVID then? Weird that somehow only NOW does the media recognize the squeeze. Definitely not because they profit on COVID fear mongering.

 

[Old_Mil]

No staffed pediatric ICU beds left​

Read between the lines. No ***staffed*** pediatric ICU beds left. That's a decision made by management on a profit/loss/bonus basis, the media is turning it to their own ends. Same situation as the Wal-Mart with 30 checkout lanes with two open.

 

[Birdstrike]

Read between the lines. No ***staffed*** pediatric ICU beds left. That's a decision made by management on a profit/loss/bonus basis, the media is turning it to their own ends. Same situation as the Wal-Mart with 30 checkout lanes with two open.

That's a very good pickup. That word was put in there for a reason, in the title, twice in the slide and in the body of the article. That's not the type of word that gets in there by accident like an "uh," or an extra "and/or." Very telling.

 

[WheezyBaby]

Our PICU has continually had every bed staffed with a census of 40ish% covid. We've been operating at capacity for 3 months and are frequently declining non-ECMO eval transfers from outside facilities. When you suddenly have COVID and RSV related severe ARDS tying up beds for weeks it stretches things just as it does in MICU, and unlike in the adult world there is little capacity to expand PICU beds or stretch the acuity on the floor because nonPICU for the most part knows **** all about taking care of sick children. We recently were at our ECMO capacity and looking states away for a kid with oxygenation index bouncing 40-70. Our ED is boarding people on occasion for days. It's more than "aDmIn WoNt PaY nUrSeS"

 

[MechEDoc]

That's a very good pickup. That word was put in there for a reason, in the title, twice in the slide and in the body of the article. That's not the type of word that gets in there by accident like an "uh," or an extra "and/or." Very telling.

Very true. I'm in the upper midwest in a small hospital. We don't keep patients on ventilators, etc. Classic critical access.

We are "full" with 12-13 inpatients, but we have the capacity for ~25 patients. Just no nurses. Same for the entire region. I couldn't transfer out to anywhere a critically ill patient. No plan B, we just had to work it out on shift.

What gives? Hospitals need money to run and they aren't getting sufficient funds to cover COVID care. Traditional profit lines are down (hips, knees, caths, scopes, etc.) and low pay / self pay are up... Given the strong correlation between getting COVID and not being able to pay your bills (uninsured, unvaccinated, unmasked, and COVID+), I suspect hospital income is sucking hard. There is no shortage of nurses. Sure, they're all burned out, but if you pay them enough, they'll work.

Medicaid / Medicare has a huge role in this crisis. Low pay, slim profit margins, and allowing understaffed hospitals to allow patients to languish with substandard care.

This was entirely foreseeable. Once the transmission dynamics of the delta strain were worked out, it was clear the much of the USA was screwed. It's like watching all the water go out in a harbor and then thinking, "hmm, interesting, let's carry on like before...", "not, run for the hills, a tsunami is coming!"

 

[Dr Mantis Toboggan]

Our PICU has continually had every bed staffed with a census of 40ish% covid. We've been operating at capacity for 3 months and are frequently declining non-ECMO eval transfers from outside facilities. When you suddenly have COVID and RSV related severe ARDS tying up beds for weeks it stretches things just as it does in MICU, and unlike in the adult world there is little capacity to expand PICU beds or stretch the acuity on the floor because nonPICU for the most part knows **** all about taking care of sick children. We recently were at our ECMO capacity and looking states away for a kid with oxygenation index bouncing 40-70. Our ED is boarding people on occasion for days. It's more than "aDmIn WoNt PaY nUrSeS"

What’s the floor bed status?

 

[WheezyBaby]

What’s the floor bed status?

Consistently full. I can't comment specifically on nurse staffing for floor beds though

 

[Fox800]

So your hospital is picking up the slack from the outlying facilities that don't want to staff their own hospitals...

Our PICU has continually had every bed staffed with a census of 40ish% covid. We've been operating at capacity for 3 months and are frequently declining non-ECMO eval transfers from outside facilities. When you suddenly have COVID and RSV related severe ARDS tying up beds for weeks it stretches things just as it does in MICU, and unlike in the adult world there is little capacity to expand PICU beds or stretch the acuity on the floor because nonPICU for the most part knows **** all about taking care of sick children. We recently were at our ECMO capacity and looking states away for a kid with oxygenation index bouncing 40-70. Our ED is boarding people on occasion for days. It's more than "aDmIn WoNt PaY nUrSeS"

 

[WheezyBaby]

So your hospital is picking up the slack from the outlying facilities that don't want to staff their own hospitals...

Quite the assumption to the make that the primary problem or anything close is hundreds of beds staffing deficit and not a supply of patients issue. Definitely just my benevolent hospital picking up the slack

 

[emergentmd]

I am so confused. When I was working in a tertiary referral center 3 yrs ago, we held pts in our ER for many hours EVERY SINGLE Winter. I mean every winter for probably a good decade, EVERY Year for 3-4 winter months, we help pts in the ER. Floor pts, ICU patients. Many months we were holding 25 pts in our 30 bed ER. I remember the daily morning huddle of all departments trying to free up bed only to see 25 pts in the ER the next morning.

So now that Covid is here, then COVID is the blame for No ICU beds?

What was the excuse pre covid when every hospital I worked at in the Winter had no ICU or floor beds?

So when covid dies down, and we are back to ER holds for ICU/floor patients, then suddenly no ICU/floor beds is not a big deal?

 

[WheezyBaby]

I am so confused. When I was working in a tertiary referral center 3 yrs ago, we held pts in our ER for many hours EVERY SINGLE Winter. I mean every winter for probably a good decade, EVERY Year for 3-4 winter months, we help pts in the ER. Floor pts, ICU patients. Many months we were holding 25 pts in our 30 bed ER. I remember the daily morning huddle of all departments trying to free up bed only to see 25 pts in the ER the next morning.

So now that Covid is here, then COVID is the blame for No ICU beds?

What was the excuse pre covid when every hospital I worked at in the Winter had no ICU or floor beds?

So when covid dies down, and we are back to ER holds for ICU/floor patients, then suddenly no ICU/floor beds is not a big deal?

I have never seen a child boarded in the ED for 48 hours for any reason other than pending inpatient psych placement. The consensus amongst our faculty is this is the worst they've seen in their career. It's a combination of COVID, RSV, and paraflu hitting simultaneously, in addition to the various things the PICU obviously cares for. We're a very high volume ECMO center and are intermittently running out of ECMO circuits to the point where there are discussions about the possibility of needing to draft an ECMO triage policy that has never been needed previously. Kindly, it's not just "winter season". Maybe, if your last experience was 3 years ago, you don't have the insight to comment on what the current experience is

 

[emergentmd]

Of course Covid is contributing to ER holds and bed shortage. But if you listen to the Media, you would think that ALL available beds are taken by covid pts which is just not true.

I know of many hospitals in Texas that are "full" not taking transfers and told by friends that they just do not have the staff causing floors/beds to close.

 

[SurfingDoctor]

If they want to pay me some of those locums rates... I'll manage them in the water closet...

 

[Fox800]

Quite the assumption to the make that the primary problem or anything close is hundreds of beds staffing deficit and not a supply of patients issue. Definitely just my benevolent hospital picking up the slack

I think it's a reasonable assumption given we are getting hit over the head with social media posts about travel nurses making bank and the nursing shortage...

 

[xDNA]

Just a nurse here, but Pediatric admittance to PICU/IMC has definitely increased. Everyday they are asking people to come in for day shifts, some night shifts we have better staffing and they float us. Last week there was like 20 admissions in 5hrs at the beginning of a night shift. I didnt go upthere but I'm sure those patient assignments were NOT appropriate, they were begging for people to come in.

 

[Siggy]

I'm confused... I was assured... ASSURED that COVID doesn't affect kids AT ALL. You mean to tell me that the "plandemic" and "let our children breath" anti-vaxx, anti-mask folks were WRONG? UnPoSsIbLe.

 

[Arcan57]

I don’t get the sense that WheezyBaby is lying about the trends they’re seeing inside their own unit. Pediatrics has some of the same market forces that adult hospitals deal with, but porting our experience with HCA style shenanigans directly onto the peds ICU situation is over generalizing.

We’ve lived with the artificial cap on resources due to CEOs trying to make their bonus by eliminating surge capacity… excuse me “right-sizing”. A parade of boneheaded execs acting like they’re the first person to ever look at a system that’s not running at 100% capacity at all times and think “But what if it did?” And it’s rightfully made us cynical. But we’ve got 1st hand evidence from someone with longitudinal experience saying it’s different and worse than they’ve seen and not just because of staffing. It seems cavalier to dismiss them just because they’re experience doesn’t fit neatly into the narrative we tell.

 

[skougess]

I'm confused... I was assured... ASSURED that COVID doesn't affect kids AT ALL. You mean to tell me that the "plandemic" and "let our children breath" anti-vaxx, anti-mask folks were WRONG? UnPoSsIbLe.

It’s not that COVID doesn’t effect children. It’s just that even as RSV currently ravages children 10x worse than COVID, NO ONE gives a **** about it. Kind of makes it seem like the COVID concern for children is mostly based on media hysteria. I think that’s a fair take.

 

[WheezyBaby]

I think it's a reasonable assumption given we are getting hit over the head with social media posts about travel nurses making bank and the nursing shortage...

Are these for PICU or MICU nursing jobs? In my experience, even though peds hospitals can absolutely suffer from the same market forces that drive administrators on the medicine side (they do, rightfully, need to be concerned about operating expenses to some degree), it doesn't happen to close to the same degree

It’s not that COVID doesn’t effect children. It’s just that even as RSV currently ravages children 10x worse than COVID, NO ONE gives a **** about it. Kind of makes it seem like the COVID concern for children is mostly based on media hysteria. I think that’s a fair take.

I would agree, pre-delta. MISC was always unique, but as sick as MISC kids can get, they get better. Some of what we've observed is probably exaggerated by the combination of relaxed social distancing, return to school, etc amidst the surge in delta, but delta certainly seems to have a more prominent effect on young individuals than prior strains. Anecdotally, most notably affecting neonates, complex chronically ill of all ages, and obese adolescents. Significant majority of viral pneumonia ECMO cannulations are COVID-related. Speaking with ECMO friends on the medicine side, they've seen similar with delta - lots more 20's / 30's and pregnant women. All unvaccinated.

 

[PTPoeny]

Are these for PICU or MICU nursing jobs? In my experience, even though peds hospitals can absolutely suffer from the same market forces that drive administrators on the medicine side (they do, rightfully, need to be concerned about operating expenses to some degree), it doesn't happen to close to the same degree



I would agree, pre-delta. MISC was always unique, but as sick as MISC kids can get, they get better. Some of what we've observed is probably exaggerated by the combination of relaxed social distancing, return to school, etc amidst the surge in delta, but delta certainly seems to have a more prominent effect on young individuals than prior strains. Anecdotally, most notably affecting neonates, complex chronically ill of all ages, and obese adolescents. Significant majority of viral pneumonia ECMO cannulations are COVID-related. Speaking with ECMO friends on the medicine side, they've seen similar with delta - lots more 20's / 30's and pregnant women. All unvaccinated.

We are seeing the same thing in my ICU. It is both winter peak RSV numbers that have lasted all summer and we have admitted more acute COVID in the last two weeks than in the rest of the pandemic combined. And the acute COVID kids spend a lot more time with us than the MISC kids. Even the kids that needed ECMO for MISC turned around in a few days.

It is staffing, but usually peds ICUs are like this for maybe two months each year. All the nurses and RTs know it will be harder to get vacation and they all plan to pick up extra shifts during that time to cover everything and make incentive money. This model doesn't work anymore 4 months into an "RSV season" that shows no sign of stopping. Nobody wants to pick up incentive shifts anymore and everyone needs their vacation time.

 

[The Knife & Gun Club]

We are seeing the same thing in my ICU. It is both winter peak RSV numbers that have lasted all summer and we have admitted more acute COVID in the last two weeks than in the rest of the pandemic combined. And the acute COVID kids spend a lot more time with us than the MISC kids. Even the kids that needed ECMO for MISC turned around in a few days.

It is staffing, but usually peds ICUs are like this for maybe two months each year. All the nurses and RTs know it will be harder to get vacation and they all plan to pick up extra shifts during that time to cover everything and make incentive money. This model doesn't work anymore 4 months into an "RSV season" that shows no sign of stopping. Nobody wants to pick up incentive shifts anymore and everyone needs their vacation time.

You hit the nail on the head. This is a multi factorial problem with actual COVID infections making up a relatively small sliver. Maybe 5-10%. Our systems are able to and regularly do handle surges of 5-10%.

The difference is that covid’s downstream effects have created ripples in multiple other streams, leading to an overwhelming of both adult and peds capacity. We’ve never had a 5 month RSV surge in the middle of summer in Florida. It just doesn’t happen. We’ve lost a few nurses to hospital poaching or travel contracts when another region gets hit with flu or RSV or whatever, but we’ve never had huge chunks of the country experience these surges at the same time.

Maybe a few pediatricians or internists would leave practice every year leading to a few extra asthma and CHF exacerbations. But now offices are astronomically more difficult for chronic X patients to get into than before.

So no, Covid INFECTIONS are not the sole cause of our current cluster f***. But the downstream effects of Covid are almost certainly to blame. The entire health system has been turned on it’s head and it was held together with duct tape and patches to begin with.