Crowded pediatric units a growing problem for community hospitals

The Pediatric Emergency Department (ED) at GBMC is one of many across the country facing a crisis.

There are too many patients, and not enough beds.

“There are 22 emergency departments in Baltimore County, and GBMC is the only fully dedicated community pediatric Emergency Department,” said Theresa T. Nguyen, MD, Chair of Pediatrics at GBMC. “The closure of the pediatric ED at Franklin Square in 2018 and UMMS—Upper Chesapeake in 2022 reduced the numbers of beds in the county significantly.”

Dr. Nguyen said decisions to close pediatric units are usually made with the hospital’s bottom line in mind, but it’s the patients who suffer the most.

“Pediatric departments are very seasonal, and sometimes, throughout the year, you could have an empty ward. Hospitals get rid of line items that lose them money,” Dr. Nguyen said.

A combination of several factors has many pediatric emergency departments struggling to keep up with the patient load, and GBMC is no exception.

“During the peak of illnesses in fall 2022, we had patients being evaluated in the hallway,” Dr. Nguyen explained. “There aren’t enough beds in the state, plus the ongoing nursing shortage, which leads to a congested ED.”

She said the problem isn’t helped by the number of behavioral health patients who need to be boarded in the pediatric ED.

“These are kids who may be suicidal or dangerous to their families. They’re waiting to get into an inpatient psychiatric program, and we are the last pediatric ED in Baltimore County, so they come here. If they need hospitalization, they stay with us while we look for beds for a psych inpatient unit,” Dr. Nguyen said.

The problem is those beds are hard to come by.

“We have 6 to 12 boarders at any time, and they’re usually here for at least a week or two,” Dr. Nguyen said.

Sometimes, these young patients must stay a lot longer. One 14-year-old patient was in the GBMC Pediatric Emergency Department for 79 days. She suffers from severe depression and has tried to commit suicide on several occasions. But a complicating issue was a severe eating disorder, which exacerbated attempts to get her the help she needed.

“We contacted 40 to 50 ped/psych units across the country, and she was turned down almost everywhere,” Dr. Nguyen said. “She hasn’t eaten food by mouth in over a year, and centers couldn’t take her in because she’s fed through a nasogastric tube.”

To make room for this patient and others like her, Dr. Nguyen says they’ve had to get creative about where to house pediatric patients.

“Boarding these kids is a need we’re meeting in our community, since there’s no one to take care of them but us, but we need money to keep the pediatric ED afloat,” Dr. Nguyen said.

Dr. Nguyen is grateful for the generous donations from foundations and fundraising campaigns, but she said there is still a growing need to expand and better serve the children of Baltimore County.

“We need solutions at a national level,” she pleaded. “Can we do something about this before we have a death here and people start to pay attention? Can we get some help for our kids?”

To support the pediatric emergency department at GBMC, please visit GBMC.org/supportpediatrics.