Study examines impact of influenza, RSV and COVID-19 hitting pediatric emergency departments

As cases of respiratory illnesses rapidly increase across the country, new research from Michigan Medicine experts offers insight into how outbreaks of respiratory illnesses can negatively impact emergency care for children in a state.

Focusing on the “tripledemia” of respiratory syncytial virus, influenza and COVID-19 infections that occurred last year, their findings highlight the importance for all types of hospital emergency departments to be prepared to care for sick children, especially when health systems are under strain.

In this study, the authors examined more than 2.7 million emergency room visits in 2021 and 2022 across 25 Michigan emergency rooms within the Michigan Emergency Department Improvement Collaborative. Their findings were published in Open JAMA Network.

The study benefits from the ability to pool data from this quality collaborative initiative.

The analysis shows that pediatric visits to viral and respiratory emergency rooms increased dramatically during the tripledemic, from September to December 2022.

During these months, these visits increased by 72% compared to the previous four months and were 16% higher than the same period in 2021.

The state’s specialty children’s hospitals have been hardest hit.

During the outbreak, wait times at children’s hospital emergency departments exceeded four hours for 8% of visits, total emergency department treatment times (also called length of stay) were greater than 12 hours for 9% of visits, and more children experienced a return. visit within 72 hours of discharge from the emergency department.

But the study also examines what happened when children carrying these viruses went to emergency departments at general hospitals across the state.

In comparison, wait times in these general emergency departments that serve a mix of children and adults were generally less than an hour, and fewer children received visits lasting more than 12 hours.

“Pediatric preparedness, an effort to ensure that all emergency departments have the appropriate resources, equipment, training and policies to provide high-quality emergency care to children, is essential for all hospitals and health systems,” wrote Alexander Janke, MD, clinical instructor at the Michigan Department of Emergency Medicine and national clinician scholar at the UM Institute for Healthcare Policy and Innovation.

“When viral illnesses surge across the state, as we did last winter, the impact varies across different emergency departments and hospitals,” he explained.

“Large children’s hospitals are the busiest, but even small rural hospitals can have a dangerous backup for pediatric care at the height of a surge.”

Previous research on pediatric preparedness shows that mortality among critically ill children is reduced when emergency departments are adequately staffed, have readily available equipment, and have plans for operating the facility during peaks like the one observed in 2022.

The current study highlights the need for all types of hospitals and emergency departments to be prepared to care for sick children.

At the height of the 2022 surge, the collaboration hosted a virtual town hall to provide a forum for emergency service leaders to share ideas on how to ease the systemic pressure of seasonal respiratory illnesses.

Representatives from across Michigan discussed emergency department operational challenges such as lack of beds and nursing expertise, insufficient pediatric preparation, and suboptimal coordination between small ERs and transfer centers and identified approaches to mitigate them.

Michelle Macy, MD, MS, Janke’s co-author highlights the importance of strong collaborative relationships across emergency departments to ensure children receive appropriate care while awaiting transfer to a pediatric emergency department or bed hospitalization.

“Children’s hospitals are positioned to take a leadership role in coordinating pediatric care between emergency departments and hospital systems,” she said.

“Preparing in advance for pediatric surge events is crucial to optimizing care for critically ill and injured children, especially given the closure of pediatric inpatient beds in community and rural hospitals across states -United.