Pediatric care has rapidly evolved over the last two decades, according to Michael Steiner, MD, lead author of a study published Oct. 30 in JAMA, and as a result inpatient care has largely been redistributed from general hospitals into children’s hospitals.
What this has meant for children's hospitals is largely an extra weight on capacity, which Dr. Steiner's research points out was highlighted by the strain faced during the 2022 respiratory syncytial virus, COVID-19 and influenza 'tripledemic' surge. During the last 20 years, pediatric hospitalizations have concentrated into fewer locations, which has also exacerbated the capacity issues these facilities can face.
Using data from the Kids Inpatient Database, Dr. Steiner and his team found that even though overall annual inpatient discharges at general hospitals for children decreased by 26.5% in the last 20 years, simultaneously the percentage of total national discharges from children's hospitals went up from 58.9% in 2000 to 81.8% in 2019.
This is concerning, particularly for those in rural regions, the authors note, because "decreased local inpatient pediatric hospitalization capacity, particularly in rural areas, may create barriers to care and decrease emergency capacity."
"Children are much less likely now to be hospitalized at their local hospitals that care for both children and adults, and much more likely to be hospitalized in higher volume children’s specialty centers," Dr. Steiner stated in an Oct. 30 news release. "Additionally, other than neonates after birth, fewer older children are having inpatient admissions. These changes have important implications for hospital planning and readiness, systems to provide high-quality child-specific transport, and capacity needs at children's hospitals."
This comes at a time when many hospitals nationwide have been forced to cut pediatric services to expand capacity for more financially sustainable care.