In the fall of 2022, hospitals across the U.S. saw a severe spike in cases of influenza, SARS-CoV-2, and respiratory syncytial virus (RSV), a phenomenon that became known as the “tripledemic.”
As someone who worked in a pediatric ICU that fall, Yale’s Nadir Ijaz understood the challenges presented by the surge in cases; indeed, news coverage at the time confirmed that children’s hospitals across the country were so overwhelmed that they were running out of beds.
“As a pediatric ICU doctor, I saw how tough it was for many kids to get the right care when they needed it,” said Ijaz, an instructor of pediatrics (critical care) at Yale School of Medicine (YSM).
In a new study, Ijaz and a team of researchers found that many hospitals that care for children were indeed completely full during the tripledemic, even though other nearby hospitals still had open beds for sick kids. Sometimes one hospital was over capacity while another hospital still had space.
The findings, published in the journal JAMA Network Open, may offer critical insights into possible strategies for preventing bed capacity overload during future pediatric surges, the researchers say.
“With pediatric hospital beds decreasing across the country, we need everyone to advocate for systems that can care for all our children when they get sick, even during surges,” said Ijaz, lead author of the study.
At the time, there was a surge across the U.S. in what is known as pediatric bed strain — reported pediatric inpatient bed shortages; in past research, pediatric bed strain has been associated with increases in lengths of stays for patients, adverse events, and even mortality.
In the fall of 2022, anecdotal evidence and media reports linked the pediatric bed strain to reductions in pediatric inpatient beds during the preceding decade. Indeed, from 2008 to 2022 the number of pediatric inpatient beds in the U.S. decreased by 19.5 %, impacting some geographic regions more than others.
For the new study, the researchers looked at whether having fewer beds — and the manner in which kids were spread across hospitals — added to the pediatric bed strain of the tripledemic. They defined “bed strain” as when more than 85% of a hospital’s pediatric beds are full. Research shows that once hospitals are over 85% full, patients often get stuck in the emergency department much longer, sometimes for days.
“Emergency departments aren’t built to care for patients that long,” Ijaz said. “Sick children should be moved into a hospital ward or ICU bed as soon as it’s safe to do so.”
The researchers combined two large datasets: one from the U.S. Department of Health and Human Services and one from the American Hospital Association. They looked specifically at bed strain at the hospitals in 254 different regions across the country from October through December 2022. They also looked at differences in the number of pediatric beds that were full across multiple hospitals located close to each other to better understand load imbalances that occurred, or whether some hospitals experienced bed strain while others did not in the same geographic area.
Through this work, the researchers discovered that almost half of the hospitals experienced bed strain (or more than 85% of beds full) during any given week. When they looked at small groups of hospitals close to each other, they found that almost two-thirds of the time, hospitals with bed strain were close to other hospitals that had more beds open to admit sick kids. They also found no association between pediatric bed strain during the tripledemic and the pediatric bed capacity changes of the preceding decade, although they note that there may not have been enough hospitals in the study to conclude this definitively.
Ultimately, researchers say, their findings will equip other researchers and policymakers to determine how to best spread sick kids out across different hospitals while making sure all sick kids get the care they need. Some states, including Washington and Oregon, tried this strategy in 2022, but it hasn’t become standard practice across the country yet.
“We will need to think outside the box and work across, not just within, hospital systems to make this happen,” Ijaz said.
Other Yale authors include Arjun Venkatesh, professor of emergency medicine and chair of the Department of Emergency Medicine at YSM; Craig Rothenberg, a statistician at YSM; Alexander Janke, a former YSM graduate student who is now clinical assistant professor of emergency medicine at the University of Michigan Medical School; and Constantin Radu, a former graduate student at the Yale School of Public Health.
This study was supported by the Yale National Clinician Scholars Program, the National Center for Advancing Translational Science, the National Heart, Lung, and Blood Institute of the National Institutes of Health, and the Society for Academic Emergency Medicine.
