Kathleen Houston kisses her seven-week-old daughter Parker as they wait in the ER for a hospital bed on Dec. 7 at Corwell Health Helen DeVos Children’s Hospital in Grand Rapids, Michigan. “There are so many kids in here that they have to take the worst ones,” Houston said.

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Kathleen Houston kisses her seven-week-old daughter Parker as they wait in the ER for a hospital bed on Dec. 7 at Corwell Health Helen DeVos Children’s Hospital in Grand Rapids, Michigan. “There are so many kids in here that they have to take the worst ones,” Houston said.

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Waiting their turn in the ER, dazed-looking parents clad in winter coats with crying babies in their arms try to catch Dr. Erica Michels’ eye. We! Vote for us next! They seem to be pleading with tired eyes.

Michels directs pediatric emergency medicine at Corwell Health Helen DeVos Children’s Hospital in Grand Rapids, Michigan. Her lips pressed into a thin line, scanning the area for what she calls “danger.”

“People were out here for two hours, which is really sad,” she said.

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Typically, DeVos Children’s ER sees about 140 children each day, according to Michels, but on a recent Tuesday in mid-December, they saw 253.

“I hate waiting,” Michiels said. But now we can’t have it any other way.

Like other children’s hospitals across the country, DeVos Children’s staff is stretched thin by patients with RSV and the occasional flu.

This surge in sick children comes years after some U.S. hospitals cut pediatric beds — in part because it’s traditionally more profitable to treat adult patients.

The remaining nursery beds are increasing in urban areas, forcing families living in rural areas to travel longer and longer distances to get the care their children need.

When the local ER cannot help

Stacy Rodriguez was desperate when she brought her nine-month-old son to the ER in their small town of Shelby, Michigan. Santi, who has big brown eyes and long eyelashes that are all curled up, has been sick for days.

At first Santi stopped eating, so she took him to urgent care. Then she went to the pediatrician because he started sleeping 20 hours a day. Rodriguez tells them everyone is fighting the virus and sends them home.

Within hours of leaving the pediatrician, Santi says, “it was much worse.” “The fever was so high. I couldn’t bring it down.” She took him to the ER, where doctors told her Santi had RSV and his oxygen saturation was dangerously low.

Rodriguez said the Shelby Hospital staff told her they couldn’t give him the care he needed, that they didn’t have the proper equipment.

Only 9 of Michigan’s 130 acute care hospitals currently have pediatric ICUs, according to the Michigan Health and Hospital Association.

Erdu wanted to transfer Santee right away, but Rodriguez said there was a nervous wait when he thought about where to send the medical team first: Muskegon was the closest, but DeVos could provide more intensive care. “So they sent us to DeVos and he had to ride in an ambulance.”

The journey took an hour. “I thought I could catch him,” Rodriguez said.

But for safety, Santi had to be strapped to the stretcher. “Luckily, he stared at me the whole time and finally fell asleep.”

A staff member at Helen DeVos Children’s Hospital cares for nine-month-old Santiago Botello Rodriguez on December 7. Santiago was transferred to the hospital. DeVos Children’s is receiving so many transfer requests, they can’t take every one. “We called 15 other places and they all said no,” Dr. Andrea Hadley said.

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A staff member at Helen DeVos Children’s Hospital cares for nine-month-old Santiago Botello Rodriguez on December 7. Santiago was transferred to the hospital. DeVos Children’s is receiving so many transfer requests, they can’t take every one. “We called 15 other places and they all said no,” Dr. Andrea Hadley said.

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Rodriguez watched the noise monitors as he told his story in a room at DeVos Children’s Hospital, which had been divided to make room for another sick infant and his family.

A moment ago, six workers gathered around Santi’s bed, talking in soft voices as they worked to thread a small feeding tube through his nostrils. Next, they held his limp arms up, and watched as he cried, so they could take X-rays to make sure the tube was in place.

Now Santi sleeps comfortably on his mother’s chest, a small oxygen tube attached to his face. Breathing labored, and struggling with sleep, he kept both eyes on his father, Saul Botello.

“I hate to see it like this,” Botello says, his hands in his sweater pockets, his own eyes glued to his son. Finally, Santi’s heavy lids were closed, and he fell into a sound sleep in his hospital bed. His mother rubs his back, coos softly.

“It will be fine, you just have to support him [this]” says Dr. Andrea Hadley, chief of pediatrics at DeVos.

Keep the kids away, or stretch the staff further?

It’s Hadley who asks if they can transfer patients from smaller hospitals or free-standing ERs in rural areas to DeVos Children’s. I get a lot of calls where they say, “We called 15 other places and they all say no.”

Large children’s hospitals like DeVos’ receive transfer requests on a regular basis. But in recent weeks, the calls have been coming from a much larger geographic area, including parts of Illinois. Patients living in Michigan’s Upper Peninsula typically go to Wisconsin for care, Hadley said. But now those hospitals are also full.

In response, DeVos Children’s doubled their rooms, squeezing two patients (and their families) into one dedicated room. The hospital does not allow more than one parent or guardian to stay overnight. Even with those changes, Hadley said, the hospital can only care for the sickest children.

“We should have said we’ll see you and support you, but we can’t bring you here yet.”

Dr. Andrea Hadley, director of pediatrics at Helen DeVos Children’s Hospital, puts two children in each room to increase capacity.

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Dr. Andrea Hadley, director of pediatrics at Helen DeVos Children’s Hospital, puts two children in each room to increase capacity.

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Hadley said they used to take all reference requests.

Staffing shortages are an increasing concern throughout the health care industry during the pandemic. Michigan has lost 1,700 hospital beds by 2020, according to the Michigan Health and Hospital Association. That has led to screening of children’s hospitals during this outbreak of RSV and influenza.

Children’s Hospital of Michigan in suburban Detroit has only enough staff to fill 60% of the beds, said Dr. Rudy Valentini, chief medical officer. When 40% of beds are not available, children who need to be admitted have to wait in the ER until a bed becomes available.

“So we have ICU patients in our emergency room who can’t get to the ICU, because there are no beds, there are no available staff beds,” Valentini said Dec. 6.

The number of pediatric patients, bed closures and staffing shortages have created a perfect storm for children’s hospitals, forcing them to make tough decisions.

“There’s also a moral dilemma associated with the thought of returning patients,” Hadley said. “And how do we address the anxiety that comes with knowing the potential, if we don’t expand a bit as a system, that there may be relapsed patients?”

But stretching staff who are already “on the brink of burnout” comes with their own risks, according to nurse manager Jamie West. On her floor at Helen DeVos Children’s Hospital, there are enough nurses to safely care for a total of 18 patients. But recently, West said, they had to stretch the same number of nurses to care for up to 33 critically ill patients. They also don’t have enough electronic monitors for every patient, Hadley added.

“These kids are so sick. [than we typically see during RSV season,]”And when you think about the nurses in the very large patient category, the nurses are very worried that their child has to go down too quickly, maybe because they’re too thin, they’re going to miss something.” .”

‘You’re not going to send us home, are you?’

In DeVos Children’s Emergency Room, Dr. Michiels is a constant blur of activity. A 12-year-old girl with an unrelenting fever is working on sepsis. The next moment, her pager is off and she’s walking down a long linoleum hall into a room designated as the “enhancement room.” The crew tries to keep that room open, which Mitchells rushes in for “the next blue baby.”

In a room at the end of the hall, Kathleen Houston cradles her seven-week-old daughter, Parker, as nurses tie a small band around the baby’s arm. Parker’s red face contorted in worry, her sobs filling the small room. Dr. Michels said to Houston, and maybe we’re going to put her in the intensive care unit.

Still, Houston couldn’t help it: “But you’re not going to send us home, are you?”

No, Michels reassures her gently. The two can stay. Houston said he spent the last several sleepless nights in and out of the ER.

Caitlin Houston kisses her seven-week-old daughter Parker as they wait for a bed to open in the emergency room, Dec. 7, 2022, at Helen DeVos Children’s Hospital at Corwell Health in Grand Rapids, Michigan.

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Caitlin Houston kisses her seven-week-old daughter Parker as they wait for a bed to open in the emergency room, Dec. 7, 2022, at Helen DeVos Children’s Hospital at Corwell Health in Grand Rapids, Michigan.

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“There are so many kids in here that they have to take the worst ones,” Houston said.

“And even at midnight two nights ago, the ER was packed. So we were there for 2 hours, waiting.”

It’s never good news to be told your child needs life-saving medical intervention, but for parents like Houston, a hospital admission can be a relief. Their son finally gets a bed.

This story comes in partnership with NPR’s Health Report. KN (Kaiser Health News) and Michigan Radio. Editing by Carrie Feibel, with photo editing by Max Posner.

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