The COVID-19 pandemic led to a steep decline in respiratory visits in 2020 due to social distancing and mask requirements. But loosened mask and public gathering restrictions in 2021 led to an unpredictable offseason surge of respiratory syncytial virus (RSV) with fewer—and increasingly burned out—staff members on hand to help care for an influx of patients.
Typical RSV season runs November through February, peaking in December and January. The southern region peaks about a month before other regions and is a leading indicator for the effect of RSV nationwide.
Through Children’s Hospital Association’s online discussion groups, chief operating officers, chief financial officers and chief nursing officers are sharing their experiences and trends they’re seeing in their hospitals. Here are common themes in each region.
Lower Midwest and Southeastern regions
In addition to an increase in COVID-19 infections, children’s hospitals are seeing RSV, rhinovirus and enterovirus. Overall, acuity is up, ED volumes are high, and most ICUs are at capacity. Staff are managing patient placement and throughput as if they were in peak viral season. Hospitals are experiencing shortages in travel nurses and applicants for vacant positions. They are experiencing high rates of nursing turnover.
Northwest and Southwestern regions
Children’s hospitals are experiencing an increase in COVID-19, RSV, rhinovirus, enterovirus and parainfluenza. ICUs are busy but not full yet. Frequent staff outages due to illness are contributing to staffing challenges. One hospital is bringing in new cohorts of graduates and new-to-pediatrics nurses for eight to 10 weeks of support after they complete basic competencies. Children’s hospitals in this region are often operating on day-to-day placement and throughput.
Eastern Midwest, Northeast and Southeastern regions
These regions are experiencing high RSV rates, PICU admissions and COVID-19 cases in patients 17 months to 18 years old. EDs are busy and seeing many of the COVID-19 cases. Staff are frequently missing work with COVID-19 symptoms, and there are not enough travel nurses. Some hospitals are starting new programs and implementing financial incentives to help with staffing challenges.
Data was pulled from Children's Hospital Association's Pediatric Health Information System® (PHIS) using Jan. 2018 through 2021 data, and PROSPECT℠ Staffing Department Volumes data for Q4 2020 to Q1 2021 compared to Q4 2019 to Q1 2021.
13%
drop in staffing for respiratory therapists in Q1 of 2021 compared to 2020, due to no RSV.
50%
greater volumes than 2019 in respiratory therapy departments for some hospitals in the south.
25%
higher volumes in some EDs compared to 2019 volumes.
