Oregon Health and Science University Y Randall Children’s Hospital are taking emergency steps to admit more children to their pediatric intensive care units. That’s happening as an increase in RSV, a common childhood virus that can be dangerous for babies and older people, has reached Oregon.
Hospitals like Oregon Hospital and Science University (above) and Randall Children’s Hospital recently had to take emergency action as their available pediatric beds became increasingly scarce.
Courtesy of Oregon Health and Science University
The hospitals represent two of only three in the state that provide intensive care, including life support, to children. OHSU representatives said all pediatric ICU beds in the state are full and it is formally moving to crisis care standards.
“Sometimes every hospital will turn away patients,” said OHSU pediatric intensive care expert Dr. Carl Eriksson. “What we are seeing now is that the collective group of hospitals is at a point where we are concerned about our ability to care for the next patient. And that’s why we’re taking the next step.”
The standards are also affecting the services available to other children who need care at the hospital level, such as adolescents in mental health crises.
OPB health reporter Amelia Templeton has been covering the crisis and joined presenter Geoff Norcross to discuss the shortage of pediatric beds in the state. Below is a full transcript of the conversation.
Editor’s note: At the time this interview was recorded, Randall Children’s Hospital had not yet declared crisis care standards.
Geoff Norcross: So we start with the crisis at OHSU. But what are you hearing from other hospitals across the state about the RSV crisis?
Amelia Templeton: RSV is really impacting a part of the healthcare system that worked well during the pandemic: pediatrics. RSV is particularly bad for very young children. A pediatrician I spoke with said his pediatric unit has been the busiest in about 10 years. She said her colleagues have told her this is a lot like what they saw during the last big flu pandemic, H1N1. [in 2009].
I spoke with OHSU and two major hospitals outside of the Portland metropolitan area, Salem Hospital and PeaceHealth Riverbend in Eugene. I hear that about half of the inpatient beds for children right now are used for RSV patients. Most RSV patients don’t need intensive care, but the sickest babies do, even things like ventilation. At this time, the three pediatric ICUs in the state are at maximum capacity.
Norcross: So with those full ICUs, what are the rest of the hospitals in the state doing?
Templeton: I think there may be a real struggle to find an ICU bed right now for pediatric patients. I heard of one case, for example, of a hospital in Medford that had tried to transfer their patient to OHSU for ICU care and was unable to do so.
The hospitals I spoke with in Salem and Eugene said they are 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 the specialized ICUs in Doernbecher. [the children’s section at OHSU] and legacy [home to Randall Children’s Hospital]. Meanwhile, Portland hospitals have been trying to put older children in adult ICUs and move babies to neonatal ICUs to create more capacity that way.
And in some cases, patients who need care at the ICU level are sent to Idaho. Hospitals in Washington and California are as full as those in Oregon; in fact, some pediatric patients from those states are ending up here.
Norcross: What do the Crisis Care Standards allow OHSU to do?
Templeton: It allows them to assign more patients to each intensive care nurse. Normally the absolute maximum for a pediatric ICU nurse would be two patients at a time. Now it could be, say, three. That will allow the hospital to immediately add more ICU beds in a nearby surgical recovery room.
Norcross: You have heard that another group of children is struggling during this RSV crisis. Adolescents in mental health crisis. Can you explain that?
Well, they are the other large pediatric population. And because Oregon has a severe shortage of specialty mental health beds for adolescents, they often end up receiving care in the emergency department or pediatric units of general hospitals. Those are the exact same places that are overwhelmed by tiny babies with respiratory problems.
Imagine you are a teenager in crisis who shows up at the emergency room; perhaps he will wait longer to be seen, and it may be more difficult to find a bed for you. Jill Pearson, Salem Health’s medical director of pediatrics, told me that she is genuinely concerned about these children.
“I really have on my mind to make sure those kids have access to health and mental health resources because we are all drowning in the surge of congestion and RSV,” Pearson said. “But I want to make sure that doesn’t limit the accessibility of those kids to come in and be seen when they need to be seen.”
Norcross: This is how the system as a whole is faring. Can you explain, on an individual patient level, what RSV looks like? Do the children recover? What can people do to help, and what do people need to know about managing this virus in their own home?
Templeton: First, I want to emphasize: Most cases of RSV can be managed at home.
The key, especially for babies, is nasal suction. Aggressive suctioning, Dr. Pearson said.
“Newborns are called ‘obligate nose breathers’ so they have to have their noses open to breathe and they won’t eat, they won’t breathe well, they’ll breathe fast, they’ll have a lot of difficulty and once they suck out their nose, they’re made like 100% better,” he said.
Keep them hydrated. You want your baby to urinate at least three times a day.
Signs for when you bring them [to the ER]: If they are breathing fast or using accessory muscles to breathe. So if you’re breathing on your stomach or contracting your clavicle muscles, it’s time to head to urgent care or the ED.
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