Pediatric ICU closures are spreading. Build the transfer network first
- Posted by Greg Wahlstrom, MBA, HCM
- Posted in Blog
Another round of pediatric intensive care closures shows that cutting low-volume children’s services is now routine, and that the real risk sits in how the sickest children get moved and received.
What changed this week
Community Medical Center in Missoula, Montana, a Lifepoint Health hospital, ended pediatric intensive care this month, according to a KFF Health News report published October 28. The hospital will keep its neonatal ICU and most pediatric services, but will stabilize critically ill children and transfer them. The nearest remaining pediatric ICU in the state is roughly 150 miles away in Kalispell. Hospital leaders cited low volume, about two ICU-level children a month, and the difficulty of staffing the unit; it has relied on rotating specialists since its last local pediatric intensivist retired eight years ago.
Missoula is not an outlier. Providence’s St. Vincent Medical Center in Portland closed its four-bed pediatric ICU last November, and the report notes recent pediatric ICU or overnight pediatric unit closures in Missouri, Illinois and California.
The longer trend
The pattern is well documented. A JAMA Pediatrics analysis of American Hospital Association survey data found US hospitals with pediatric inpatient units fell from 1,749 in 2008 to 1,226 in 2022, a drop of nearly 30%, while pediatric beds declined 19.5%. Adult capacity shrank only modestly over the same years. A separate study in Pediatrics found the number of hospitals performing pediatric appendectomies fell by about half between 2003 and 2022.
The economics explain much of it. Roughly half of US children are covered by Medicaid or CHIP, children’s volumes are seasonal and thin outside large markets, and pediatric nurses and intensivists are scarce. As Medicaid eligibility tightens and enrollment falls, the pressure on these service lines will grow.
Where the risk moves
Closing a unit does not remove the patients. It shifts risk to the emergency department, the transport system and the regional children’s hospital. During the 2022 respiratory surge, small emergency departments sometimes called 10 to 20 hospitals before finding a bed for a child. Clinicians quoted in the report warn that delays could mean children arrive at regional hubs sicker, though outcome data are still limited.
For leaders weighing a pediatric service-line decision, or receiving the patients when a neighbor closes, the work should include:
- Written transfer agreements with guaranteed acceptance and a single call line, tested before the winter respiratory season.
- Emergency department readiness: pediatric equipment, weight-based dosing tools, regular simulation and a named pediatric readiness lead.
- Telehealth consults with a pediatric critical care team so local physicians can stabilize children while transport is arranged.
- Surge planning with regional partners, including how adult ICU beds would be used for older children when hubs fill.
- Community and board communication that explains what services remain and how the sickest children will be cared for.
Executive takeaway: Treat any pediatric unit closure, yours or a neighbor’s, as a patient safety project, not just a budget line. Before winter, confirm transfer agreements, emergency department pediatric readiness and regional surge plans are in writing and have been tested.