Inside a children’s hospital: Struggling to cope with a rise in respiratory illness
Waiting their turn in the emergency room, dazed-looking parents in winter coats cradling crying babies, trying to get Dr. Erica Michiels’ attention. We! Choose us next! they seemed to beg with tired eyes.
Michiels directs pediatric emergency medicine at Corewell Health Helen DeVos . Children’s Hospital in Grand Rapids, Michigan. Lips pursed into a thin line, she surveyed what she called the “disaster” area.
She said: “Everybody was here waiting for a few hours, it was heartbreaking.
Normally, the emergency room at DeVos Children’s receives about 140 children a day, according to Michiels, but as of a recent Tuesday in early December, they were taking in 253.
“I hate waiting,” sighed Michiels. “But for now, we can’t do anything else.”
Like many other children’s hospitals across the country, staff capacity at DeVos Children’s has been strained by the wave of RSV patients and growing flu.
The rise of sick children is coming after years in the US hospital cut in the pediatric bed – in part because it is often more profitable to treat adult patients. The remaining number of children’s beds is increasingly concentrated in urban areas, causing families in rural areas to have to travel longer distances to take care of their children.
When Staci Rodriguez brought her 9-month-old son to the emergency room in their hometown of Shelby Township, Michigan, she was devastated. Santiago Botello Rodriguez, whose big brown eyes and long eyelashes make everyone laugh, has been sick for several days. Santi stopped eating at first, so she took him to urgent care, she said. Then he started sleeping 20 hours a day, so Rodriguez went to see his pediatrician. She said she was sent home, after being told that Santi was just battling a virus.
However, within hours of leaving the pediatrician, Santi’s condition was “a lot worse,” says Rodriguez. “His fever was too high. I can’t take it down.” She took him to the emergency room, where doctors told her that Santi had RSV and that his oxygen saturation was dangerously low.
Rodriguez said staff at Shelby hospital told her they couldn’t give him the care he needed and they didn’t have the right equipment.
Of the 130 acute care hospitals in Michigan, 10 currently have children’s ICUs, according to Michigan Hospital & Medical Association.
The emergency room wanted to move Santi right away, but Rodriguez said they had to wait a long time first while the medical team considered where to send him. A hospital in Muskegon is much closer, but DeVos can provide more intensive care.
“So they sent us to DeVos, and he had to get in an ambulance,” she said. The trip takes an hour. “I thought I would be able to keep him.”
But for safety, Santi needs to be strapped to a stretcher. “Luckily, he just stared at me the whole time, then eventually fell asleep,” she said.
Rodriguez watched as the screen beeped as she recounted their story in the hospital room at DeVos Children’s, which had been separated to make room for another sick infant and his family.
Moments ago, six employees had gathered around Santi’s bed, speaking in soft voices as they threaded a small feeding tube through his nostrils. Next, when Santi cried, they held down the boy’s chubby arm to keep him still so they could take an X-ray to confirm that the tube was properly placed.
Then, Santi lay comfortably on his mother’s chest, a small oxygen tube taped to his face, his breathing labored, as he struggled to sleep. The child glued both eyes to his father, Saul Botello.
“I hate to see him like this,” Botello said, hands in pockets of his sweater, his eyes fixed on his son. Finally, Santi’s heavy eyelids closed, and he fell into a restless sleep in the hospital crib. His mother rubbed his back, softly told him.
“He will be fine, just support him through [this],” said Dr. Andrea Hadley, chief of pediatrics at DeVos.
Hadley received desperate calls from smaller hospitals or independent emergency rooms in rural areas, asking if they could refer their patients to DeVos Children’s. “I got a lot of calls and they said, ‘We called 15 other places and they all refused.’”
Large children’s hospitals like DeVos regularly receive requests to transfer schools. But in recent weeks, calls have come from a much broader geographic area, including parts of Illinois. Hadley said patients living on Michigan’s Upper Peninsula often go to Wisconsin for care, but now those hospitals are also full.
In response, DeVos Children’s doubled the number of rooms, squeezing two patients (and their families) into single-person rooms. The hospital also does not allow more than one parent or guardian to stay overnight.
Even with those changes, Hadley said, the hospital is only capable of caring for the sickest of children.
“We had to say, ‘We see you, we’ll support you, but we can’t get you here yet,’” she said.
Previously, Hadley said, it would take all referral requests from other hospitals. Across the healthcare industry, staffing shortages during the pandemic are adding to the stress. Michigan has lost 1,700 staffed hospital beds since 2020, according to the Michigan Hospital & Medical Association. That leaves children’s hospitals scrambling for this RSV and flu outbreak.
At Children’s Hospital Michigan, there’s only enough staff to cover about 60 percent of the beds, according to chief medical officer, Dr. Rudy Valentini. With 40% of beds not available, children requiring hospitalization must wait in the emergency room until a bed becomes available.
“So we have ICU patients in the emergency department who can’t get to our ICU,” Valentini said Dec.
The overwhelming number of pediatric patients, bed closures and staff shortages created the perfect storm for children’s hospitals, forcing them to make tough decisions.
“There is also an ethical issue associated with the thought of having to refuse patients,” says Hadley.
“And how do we balance that suffering knowing, is it possible – if we as a system don’t last a little longer – that there could be patients who are denied?”
Jamie West, nurse manager at DeVos, said lengthening staffing that is already “on the verge of burnout” comes with its own set of risks. On her floor there are enough nurses to safely care for 18 patients. But recently, West said it had to stretch the same number of nurses to care for up to 33 critically ill patients. Hadley added that they also don’t have enough electronic screens for every patient.
“These children are much sicker [than we typically see during RSV season]West said. “And when you think about the nurses who have taken on very large patient assignments, the nurses are very worried that their children are going downhill very quickly, that they might be missing out on something because of them. too thin.”
At DeVos Children’s, Michiels is a continuous motion blur. At one point, the emergency physician was testing a 12-year-old boy for sepsis with no fever. The next moment, her pager rang and she strode down the long linoleum corridor to the room designated as the “resuscitation room.” Employees try to keep that room open for the “next blue baby” to rush in, Michiels said.
In a room at the end of a hallway, Caitlyn Houston held her 7-week-old daughter, Parker, as nurses tied a small bandage around the baby’s swinging arm. Parker’s flushed face contorted with grief, her cries filling the small room. We’ll take her in, Michiels told Houston – probably to the children’s intensive care unit.
Still, Houston couldn’t help but ask: “But you’re not going to send us home, are you?”
No, Michiels gently reassured her. Two people can stay. Houston said they spent many sleepless nights in and out of the emergency room.
“There are so many kids here that they have to take in the really bad ones,” Houston said. “And even two nights ago, at midnight, the emergency room was full. So we were there for two hours, waiting.
Being told that your child may need life-saving medical intervention is never good news, but for parents like Houston, being admitted to the hospital brings relief. Their child finally gets a bed.
This article is from a partnership that includes NPR, Michigan Radio, and KHN.