Successful Management of Pediatric Surge Events Through Statewide Medical Operations Coordination Centers

A case report published in Pediatric Critical Care Medicine examines the successful use of statewide Medical Operations Coordination Centers to manage a surge in pediatric patients during a severe respiratory outbreak, enabling load balancing and rapid expansion of clinical capacity. 

Widespread overcapacity in pediatric hospitals is a limiting factor to specialized care, particularly during pediatric surge events. The Medical Operations Coordination Centers (MOCCs) in Washington and Oregon have been effective in coordinating and balancing access to pediatric specialty care during these surges, using tools like nurse coordinators and real-time bed capacity systems. The recent convergence of severe respiratory illnesses in the US has further strained the pediatric health care system, highlighting the need for adaptable resources and coordination to address future surge events. 

The Washington Medical Coordination Center (WMCC) serves as a backup for hospitals that cannot follow normal referral patterns for specialty medical services. The Oregon Medical Coordination Center (OMCC) was formed through collaboration between health systems in the Portland region and utilizes a centralized nurse to manage hospital requests for patient load balancing. 

Both MOCCs use various tools to monitor bed capacity and conduct regional meetings with key stakeholders to assess hospital constraints and capacity in real-time. Physician communication plays a crucial role in coordinating patient movement decisions. 

During a respiratory surge from November 2022 to December 14, 2022, MOCCs received a total of 186 requests for pediatric patients unable to be placed in hospitals, with 171 from Washington and 15 from Oregon. Most of these requests were for very young children, with 16% being 3 months or younger and 37% less than 1 year old, all presenting with acute viral respiratory disease. Majority of the requests were for critically ill children and came from populated regions, with only 17% coming from rural hospitals, all of which were critical access hospitals serving rural communities with 25 beds or less and continuous emergency services.  

In Washington, out of the 171 requests for transfer assistance, the WMCC SME was utilized for 59 of them. In 14 of these cases, the patient's condition changed after the SME consultation, with eight patients being either admitted or discharged from the referring hospital. Four patients were downgraded from critical to acute care, one was upgraded from acute to critical care, and one was transferred from a PICU bed to a level 3 NICU. After the SME consultation, 15% of the requests remained at the originating facility, with seven patients being downgraded from ICU to acute care, seven being discharged home, and one being upgraded to critical care. In Washington, a total of 28 patients were placed in hospitals with pediatric acute care but no critical care capabilities, with one later being transferred for ICU level care. 

“Washington and Oregon statewide MOCCs have leveraged centralized coordination to effectively load balance a surge in pediatric patients which has overwhelmed existing pediatric hospital resources,” said the report.  

This achievement was attributed to centralized coordination, surveillance informing pediatric hospitals and policy makers of unmet clinical needs, facilitating rapid expansion of clinical capacity, and modifications to referral processes. Integration of pediatric SMEs is noted as important for efficient triage of resources.   

Reference 

Steven M H, Matthias M J, Carl E O, et al. Using two statewide Medical Operations Coordination Centers to load balance in pediatric hospitals during a severe respiratory surge in the United States. Pediatric Critical Care Medicine. 2023;24(9):775-781. doi:10.1097/PCC.0000000000003301