A bed for every child who needs one

As you might have read in recent stories in The Seattle Times ["Code-red situation has local hospitals diverting patients," Local News, March 22], Children's Hospital & Regional Medical Center recently had to turn away five sick children because of a lack of available intensive-care unit beds. When your child is in need of care, there is nothing more concerning than finding out that the hospital meant for children is full and unable to admit your child. It goes without saying that the current situation pains me and all of us at Children's because we owe it to the children of Seattle, King County and the Northwest to have a bed available when they need it.

As chief nursing officer, I have not seen this level of patient need before in my 25 years at Children's. We have been at or near maximum capacity since December. While I am proud to say the medical team has implemented innovative measures to provide excellent health care for this unprecedented volume of patients, it is more urgent than ever that Children's expands to meet today's needs and those of the next generation of children.

The recent sharp spike in admissions is due in part to an early winter viral and respiratory season, which is affecting hospitals across the region. At Children's, this is compounded by the increasing number of children with chronic, lifelong diseases, such as cystic fibrosis or sickle cell anemia. It is a wonderful thing that these seriously ill children are living longer than ever before — a true achievement of pediatric research and medicine. But they are also requiring more care and services than ever before, and chronically ill children now account for 67 percent of all patients.

Because these patients are more likely to have unplanned admissions for additional acute illnesses, such as flu outbreaks and infections, this population puts extra pressure on our Emergency Department (ED). Over the past year alone, our ED has seen a 22 percent increase in volume, with a fifth of ED visits resulting in admission to the hospital. To accommodate these unplanned admissions, we strive to keep 25 to 30 percent of our beds open, but in the past months, our occupancy rate has often ranged between 90 to 100 percent, allowing for very few open beds.

What can we do to help solve this problem?

To handle this recent increase in demand, we moved swiftly to create solutions that would help patients and families with the most urgent needs. For example, we created a 10-bed short-term observation area near the Emergency Department; and we continue to work with parents to reschedule elective surgeries and to help families find adequate housing throughout any additional delay period.

We also brought together leaders from all areas of the hospital to think creatively about how we could streamline our efforts to most efficiently and safely treat our patients. In the past, efforts like these have prevented us from needing to divert young patients elsewhere, but this year, demand has outpaced our capacity and that of hospitals across the region.

Looking at the bigger picture, we have already begun to relocate outpatient care and research efforts away from the main hospital. This allows us to free up on-site resources while bringing care out to the communities we serve.

We expect the inpatient surge to lessen a bit as the viral and respiratory season comes to an end. However, that won't prevent this from happening again next year, so we are looking at our options to squeeze a few more beds into our existing footprint in the next 12 to 24 months.

To address the capacity crunch over the long term, we have begun to plan an expansion of the main hospital. We are currently working with the city of Seattle and the community through an open public process to plan for our growth, aiming to add 130 to 180 beds by 2012, and a total of 250 to 350 beds over the next 15 to 20 years.

By adding these beds, we will be able to meet projected needs of children suffering pediatric illness all across our region for years to come.

If we do not move now to expand, we will continue to risk having to turn away children periodically. For children who need a heart, liver or intestine transplant, the next closest children's hospital able to provide the specialty treatment they need is in California. Certainly, if we cannot move forward in a timely manner, we will continue to endure the kind of strain that running near or at capacity puts on the entire system, not to mention on young patients and their families.

Achieving this growth ensures that a bed will be available for every child who needs one.

Susan Heath is senior vice president and chief nursing officer at Children's Hospital and Regional Medical Center in Seattle. She also serves as assistant dean of clinical-nursing practice at the University of Washington, School of Nursing. Contact her at susan.heath@seattlechildrens.org