Providing Pediatric Care More Efficiently

Several organizations in the Baltimore and Washington, D.C. market have leveraged this hub of pediatric activity to create a more efficient model of providing inpatient pediatric services in their communities: combining pediatric emergency and inpatient services into one unit.

Franklin Square Hospital Center, Greater Baltimore Medical Center, Howard County General Hospital, and Suburban Hospital have all taken the bold step of creating a pediatric emergency and inpatient unit. While each model has been developed to meet the unique needs of the hospital, medical staff, and community, similar features include:

• Consolidation of pediatric inpatient, observation, and emergency services into a distinct unit adjacent to the main emergency department; in some cases, several beds may be flexed between inpatient and ED patients as census demands
• 24/7 in-house pediatrician coverage to treat pediatric emergency patients and inpatients; several organizations also use emergency medicine physicians as volume dictates
• Round-the-clock staffing by pediatric-trained nurses

The units at these four hospitals are profiled below.

Benefits of the Combined Approach

Initial reports from the recently developed programs and more long-term indicators from Howard County General Hospital suggest that benefits of this model include:

• Successful recruitment and retention of experienced pediatric nurses interested in working exclusively with children
• Increased utilization and productivity of pediatric hospitalists
• Growth in pediatric volume; ED visits at Howard County increased from 6,000 to 19,000 in eight years (driven also by 2 to 3 percent annual population growth)
• Reduction in overhead and staffing costs when compared to a dedicated inpatient unit
• Provision of care in a child-focused and family-friendly environment with increased patient and family satisfaction
• Consolidation of pediatric-specific supplies and other resources in one area
• Increased capacity in main ED, assuming the new pediatric unit is located in incremental space

Key Considerations

Emergency medicine physician support and facility constraints are two key factors to examine when considering the combined ED/inpatient pediatric unit. The treatment of pediatric cases by a pediatrician rather than an ED physician will have revenue implications for an emergency medicine group that receives its income from professional fee billings, rather than a salary structure. This impact may be offset by the incremental capacity that can be handled in the main department or through coverage by the ED physicians within the combined pediatric unit at peak times.

The ideal location for this type of unit is adjacent to the emergency department to enable appropriate sharing of supplies and support services. Due to facility constraints, several organizations created the combined pediatric ED/inpatient unit as part of a major ED expansion project.

Combining pediatric emergency and inpatient services is emerging as a potential option for community hospitals seeking to provide high-quality pediatric care in a cost-effective manner.

For more information on pediatric inpatient and emergency services, contact Erica Baittinger or Alan Zuckerman, or call 215-636-3500.