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Key takeaways
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Pediatric inpatient units at U.S. hospitals decreased by ~30% from 2008 to 2022, and many of these closures were in rural areas.
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This decline is significantly higher than the rate of adult inpatient unit closures in the same period.
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The onset of the COVID-19 pandemic only made a slight impact on the loss of pediatric units.
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Future studies will examine if patient outcomes or costs have been impacted by this ongoing decline.
Research study background
According to a recent analysis published in JAMA Pediatrics, nearly 30% of the nation’s pediatric inpatient units and almost 20% of pediatric beds closed between 2008 and 2022. This significantly outpaces declines in adult inpatient capacity, which during the same period, decreased units and beds by 4% and 3%, respectively.
Emily M. Bucholz, MD, PhD, a fetal and pediatric cardiologist at Children’s Hospital Colorado, co-authored the report, which updates a prior study with the inclusion of COVID-19 related data. Study authors used American Hospital Association annual survey data (excluding specialty and long-term hospitals) to compare pediatric and adult hospital access. Of the 4,808 hospitals analyzed in the study, 2,074 reported ever having inpatient beds set up and staffed for pediatric care.
As inpatient capacity continues to decline in the U.S., more children are being transferred from general hospitals to large pediatric specialty centers, requiring patients to travel farther distances. Among pediatric units open at any time during the study period, 52% closed in rural areas, compared to 41% in micropolitan and 33% in metropolitan areas.
“The closure of adult inpatient units particularly in rural areas has attracted a lot of attention. However, pediatric inpatient units closed at a rate of seven to eight times higher than adult units from 2008 to 2022. These closures have been most dramatic in rural areas, leaving millions of children without direct access to pediatric inpatient care.”
- EMILY M. BUCHOLZ, MD, PHD
The only significant immediate change to pediatric inpatient capacity related to the onset of the pandemic was a 3.4% decrease in pediatric beds. Before the pandemic, pediatric units declined by 2.2% per year and beds by 1.4% per year, while adult units and beds declined 0.4% and 0.3% per year, respectively.
Clinical implications
Potential contributors to the sustained decrease in pediatric inpatient capacity included narrower revenue margins compared to adult beds, ongoing pediatric staffing shortages, the need for specialized pediatric resources and some pandemic-related bed conversions going unchanged.
“While it may not be economically or logistically feasible to have pediatric inpatient units within 60 minutes of every area of the country, we can do better to allocate these units and develop referral networks to rapidly triage and care for children,” Dr. Bucholz said.
Innovative approaches could help halt further declines, noted study authors. They are planning a future study to evaluate if pediatric outcomes and costs have been impacted by these closures.
Featured researcher
Emily Bucholz, MD
Pediatric Cardiologist
The Heart Institute
Children’s Hospital Colorado
Assistant Professor
Pediatrics-Cardiology
University of Colorado School of Medicine
