Director of Nursing at WakeMed

The lasting effects of the global pandemic will not be seen for many decades to come. Healthcare found itself in a storm of unknowns with little certainty in anything. One calamity that is being overlooked is the impact the pandemic has had on access to pediatric inpatient and specialty care. The financial impact of the pandemic, in conjunction with the sharp decrease in pediatric admissions, led to the closure of many pediatric units across the United States.

Most pediatric patients are cared for in community-based hospitals, which account for roughly 70 percent of all pediatric admissions. Since 2021, the number of available pediatric inpatient units has decreased by 19 percent, leaving our most vulnerable patients at risk. Greater effects are being seen in rural areas where healthcare access was already limited. The closure of these units has led to a critical situation for many of our nation's children with greatly increased regionalization. Most specialized care is narrowed to freestanding children's hospitals or large academic medical centers. Of those units that have not already closed, those that are not associated with a pediatric intensive care unit are more likely to close in the future.

“Those in hospital leadership in conjunction with lawmakers need to make children’s services a priority to work towards healthier children and families.”

The financial demand of the pandemic, in conjunction with many changes in the payor mix and Medicaid challenges, has contributed to the decrease in access. At a time when hospitals must scrutinize every dollar spent, most pediatric units have become less profitable. More emphasis needs to be placed on the well-being of our communities by increasing the provision of high-quality pediatric primary care in those areas with the least amount of access. Expansion of telehealth services for pediatric specialists should be considered through partnerships with academic medical centers and children's hospitals. Access to qualified pediatric staff should be a priority for community hospitals, especially those in rural areas. Relationship building instead of competitiveness should become a priority among community hospitals.

With regionalization also comes longer wait times for appointments, leaving children more vulnerable. Transport to a larger facility to receive inpatient care contributes to increased morbidity and mortality in addition to the larger associated costs of transferring patients to other locations. The financial burden placed on families that may already be strained should also be considered, as many will not have the means to get their children to a location that can provide care. Most families assume that their local hospital can care for anyone and are not prepared to hear that they cannot. State and local lawmakers should thoroughly investigate the access pediatric patients have in their districts and work to formulate incentives and higher payments to those pediatric units that are more vulnerable to closure. Medicaid expansion should include specific emphasis on the pediatric population with the idea of working towards better meeting the needs of the patients.

Here in North Carolina, we are fortunate to have some of the most exceptional children's hospitals in the country. Yet, we remain regionalized, with the most access available in the center of the state. Those in hospital leadership, in conjunction with lawmakers, need to make children's services a priority to work towards healthier children and families.