Oregon Health and Sciences University and Randall Children’s Hospital are taking emergency action to admit more children to their pediatric intensive care units. It comes as an increase in RSV, a common childhood virus that can be dangerous to infants and the elderly, hit Oregon.
The hospitals represent two of only three hospitals in the state that provide critical care, including intensive care, to children. OHSU officials said all pediatric intensive care beds in the state are full and it is officially moving to crisis care standards.
“Every hospital will sometimes turn away patients,” said OHSU pediatric critical care expert Dr. Carl Eriksson. “What we are seeing now is that the collective group of hospitals is at the point where we are concerned about our ability to serve the next patient. And that’s why we’re taking this next step.
The standards also affect services available for other children requiring hospital care, such as adolescents in mental health crisis.
OPB health reporter Amelia Templeton covered the crisis and she joined host Geoff Norcross to discuss the scarcity of pediatric beds in the state. A full transcript of the conversation follows.
Editor’s note: At the time this interview was recorded, Randall Children’s Hospital had yet to declare standards for crisis care.
Geoff Norcross: So we started with the crisis at OHSU. But what are you hearing from other hospitals in the state about the RSV crisis?
Amelia Templeton: RSV is having a real impact on a part of the healthcare system that has done well during the pandemic: pediatrics. RSV is particularly harmful to very young children. A pediatrician I spoke to said it was the busiest on his pediatric unit for about 10 years. She said colleagues told her it looked a lot like what they saw during the last major flu pandemic, H1N1 [in 2009].
I spoke with OHSU and two major hospitals outside of the Portland metro area, Salem Hospital and PeaceHealth Riverbend in Eugene. I heard that about half of the children’s hospital beds are currently used for patients with RSV. Most RSV patients don’t need intensive care, but the sickest babies do – right down to things like ventilation. Currently, all three pediatric ICUSs in the state are at full capacity.
Norcross: So, with these ICUs at full capacity, what are the other hospitals in the state doing?
Templeton: I think there may be a real struggle to find an intensive care bed right now for pediatric patients. I’ve heard of one case, for example, of a hospital in Medford that tried to get their patient transferred to OHSU for care at the critical care level and couldn’t.
The hospitals I spoke to in Salem and Eugene said they were doing a few things to handle this situation. They are trying to expand the level of care they can provide locally, to save space for the sickest pediatric patients in Doernbecher’s specialist intensive care units. [the children’s section at OHSU] and Legacy [home to Randall Children’s Hospital]. Portland hospitals, meanwhile, have tried moving older children into adult intensive care units and moving babies into neonatal intensive care units to create more capacity.
And in some cases, patients who need care at the intensive care level are sent to Idaho. Hospitals in Washington and California are just as full as Oregon – in fact, some pediatric patients from those states end up here.
Norcross: What does the Crisis Care Standards allow OHSU to do?
Templeton: This allows them to assign more patients to each critical care nurse. Normally, the absolute maximum for a pediatric critical care nurse would be two patients at a time. Now, that could be, say, three. This will allow the hospital to immediately add more intensive care beds in a nearby surgical recovery room.
Norcross: You have heard that another group of children are struggling during this RSV crisis. Teenagers in mental health crisis. Can you explain that?
Well, they’re the other big pediatric population. And because Oregon is sorely lacking in specialized mental health beds for teens, they often end up seeking treatment in the emergency department or general hospital pediatric units. These are exactly the same places that are overwhelmed by tiny babies with respiratory problems.
Just imagine that you are a teenager in crisis who presents to the emergency room – you will wait longer to be seen, perhaps, and it may be more difficult to find you a bed. Jill Pearson, medical director of pediatrics at Salem Health, told me she was really concerned about these children.
“I really think about these kids having access to health and mental health resources because we’re all drowning in the tide of congestion and RSV,” Pearson said. “But I want to make sure it doesn’t limit the accessibility of these kids so they can really come in and be seen when they need to be seen.”
Norcross: This is how the system as a whole is doing. Can you explain, at the individual patient level, what RSV looks like? Are the children recovering? What can people do to help and what do they need to know about managing this virus at home?
Templeton: First, I want to point out that most cases of RSV can be treated at home.
The key, especially for babies, is nasal suctioning. Aggressive suctioning, Dr. Pearson said.
“Newborns are called ‘required nose breathers’ so they have to have their nose open to breathe and they won’t eat, they won’t breathe well, they’ll breathe fast, they’ll have a really hard time and once you suck on their nose out, they are 100% better,” she said.
Keep them hydrated. You want your baby to pee at least three times a day.
Signs for when you bring them [to the ER]: If they breathe rapidly or use accessory muscles to breathe. So if they’re breathing through their stomach or pulling muscles through their collarbone, it’s time to head for emergency care or the ER.
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