by Melissa Rohman, Northwestern University

Credit: Pixabay/CC0 Public Domain

From 2008 to 2022, U.S. hospitals closed nearly 30% of pediatric inpatient units but only 4.4% of adult inpatient units, according to a recent Northwestern Medicine analysis published in JAMA Pediatrics.

The hospitalization of pediatric patients generally occurs in general hospitals, though recent work led by Michelson has shown that general hospitals are more likely to transfer these patients rather than hospitalize them due in part to inpatient unit closures.

Whether this trend has persisted due to the COVID-19 pandemic has remained unclear, even as cases of pediatric respiratory illness have risen drastically in recent years, said Kenneth Michelson, MD, MPH, associate professor of Pediatrics in the Division of Emergency Medicine and senior author of the study.

"The motivation for this study was that inpatient unit closures in children were dropping for a decade until 2018. We wanted to see if that continued with the pandemic, as there was some concern that pediatric beds were being converted to adult beds," Michelson said.

Using data from the American Hospital Association Annual Survey, Michelson and colleagues studied reports from more than 4,800 U.S. medical-surgical hospitals from 2008 to 2022 to identify the number of pediatric inpatient units (defined as hospitals with any inpatient beds set up and staffed for pediatric care) and the number of pediatric beds, adult units/beds and closures.

Of more than 4,800 hospitals studied, the investigators found that only 2,074 (43%) reported having a pediatric inpatient unit. Furthermore, the number of pediatric inpatient units decreased by 30% between 2008 and 2022, and the number of pediatric beds decreased 19.5% during this time frame.

Meanwhile, adult inpatient units decreased by 4.4% and the number of adult beds decreased by 3% from 2008 to 2022, the investigators found.

"The most significant finding is that the trend did persist unabated after 2018 through 2022," Michelson said.

The investigators cited several potential reasons for these pediatric inpatient closures, including that adult beds generate more revenue than pediatric beds, pediatric staff shortages make units difficult to operate, pediatric hospitalizations are increasingly complex and require specialty resources and that pandemic bed conversions may not have been rolled back.

"This is important because it does call for policy solutions to pediatric capacity and access losses. Our next steps are to study which policy solutions would be most effective at mitigating the losses in national inpatient capacity," Michelson said.

More information: Kenneth A. Michelson et al, National Trends in Pediatric Inpatient Capacity, JAMA Pediatrics (2024). DOI: 10.1001/jamapediatrics.2024.5110

Journal information: JAMA Pediatrics 

Provided by Northwestern University