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A Statewide Assessment of Pediatric Emergency Care Surge Capabilities
Insights
Massachusetts pediatric inpatient capacity is limited during disasters. While more hospitals can offer respiratory therapies, most lack essential surgical subspecialists for children, impacting surge planning.
Area of Science:
- Public Health Preparedness
- Pediatric Healthcare Capacity
- Disaster Medicine
Background:
- Decreasing pediatric inpatient capacity necessitates effective surge planning.
- Assessing pediatric bed capacity, therapies, and subspecialties is crucial for disaster readiness.
- Massachusetts faces challenges in maintaining pediatric care during emergencies.
Purpose of the Study:
- To evaluate pediatric inpatient bed capacity in Massachusetts under standard and disaster conditions.
- To assess the availability of clinical care therapies and subspecialties for pediatric patients during emergencies.
- To inform pediatric surge planning strategies statewide.
Main Methods:
- Utilized Massachusetts Department of Public Health data for standard bed capacity (May 2021).
- Conducted a statewide survey of hospital emergency management directors (May-August 2021) for disaster capacity, therapies, and subspecialties.
- Calculated potential additional pediatric inpatient beds and assessed therapy/subspecialty availability during standard and disaster operations.
Main Results:
- 58 out of 64 Massachusetts hospitals (91%) responded to the survey.
- 19% of licensed inpatient beds are pediatric (n=2159); 171 additional beds could be available during a disaster.
- Respiratory therapies (e.g., high flow nasal cannula) availability increased from 36% to 69% in a disaster. General surgery was the only subspecialty consistently available (>50%) during standard operations, with orthopedic surgery available in a disaster scenario.
Conclusions:
- Massachusetts faces significant limitations in pediatric inpatient capacity during disaster scenarios.
- While respiratory therapy availability improves during surges, a critical shortage of pediatric surgical subspecialists persists.
- Findings highlight the urgent need for improved pediatric disaster preparedness and resource allocation.
Background:
Pediatric surge planning is critical in the setting of decreasing pediatric inpatient capacity. We describe a statewide assessment of pediatric inpatient bed capacity, clinical care therapies, and subspecialty availability during standard and disaster operations in Massachusetts.
Methods:
To assess pediatric (<18 years old) inpatient bed capacity during standard operations, we used Massachusetts Department of Public Health data from May 2021. To assess pediatric disaster capacity, therapies, and subspecialty availability in standard and disaster operations, we performed a state-wide survey of Massachusetts hospital emergency management directors from May to August 2021. From the survey, we calculated additional pediatric inpatient bed capacity during a disaster and clinical therapy and subspecialty availability during standard and disaster operations.
Results:
Of 64 Massachusetts acute care hospitals, 58 (91%) completed the survey. Of all licensed inpatient beds in Massachusetts (n = 11 670), 19% (n = 2159) are licensed pediatric beds. During a disaster, 171 pediatric beds could be added. During standard and disaster operations, respiratory therapies were available in 36% (n = 21) and 69% (n = 40) of hospitals, respectively, with high flow nasal cannula being most common. The only surgical subspecialist available in the majority of hospitals (>50%) during standard operations is general surgery (59%, n = 34). In a disaster, only orthopedic surgery could additionally provide services in the majority hospitals (76%; n = 44).
Conclusions:
Massachusetts pediatric inpatient capacity is limited in a disaster scenario. Respiratory therapies could be available in more than half of hospitals in a disaster, but the majority of hospitals lack surgical subspecialists for children under any circumstance.
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