Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States

Abstract

Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.

Figure

Predictive model of hospital occupancy during 11-week outbreak of pandemic influenza A (H1N1) 2009 in the United States, by ED IRI admission rate and ED IRI volume, using fall 2009 pandemic period data as baseline. Percentages given indicate hospital admission rate during period or for hypothetical scenario. Gray area indicates 100% occupancy. Each circle represents median occupancy from 1 hospital; vertical whiskers indicate interquartile range. y-axes indicate percentage occupancy; x-axes indicates individual hospitals. Median (interquartile range) occupancy across study hospitals: A) 95.9% (85.0%–100.3%); B) 97.9% (80.5%–102.7%); C) 109.7% (97.9%–117.1%); D) 102.2% (91.7%–112.4%); E) 108.0% (96.4%–114.9%); F) 132.4% (124.5%–145.5%). Letters correspond to scenarios in Table 3. *MMWR reporting weeks 35–45 (September 5–November 20, 2009). †MMWR reporting weeks 44–53 (November 1, 2003–January 9, 2004). ED, emergency department; IRI, influenza-related illness; MMWR, Morbidity and Mortality Weekly Report (Centers for Disease Control and Prevention, Atlanta, GA, USA).