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Amid 'tripledemic,' Nebraska hospitals working with Midwest centers to find open beds for kids

An empty hallway in the pediatric care unit at Bryan Health East Campus in Lincoln, with the walls painted with a prairie scene.
Bryan Health
/
A hallway in the pediatric care unit at Bryan Health East Campus in Lincoln.

Multiple Nebraska hospitals are struggling to care for all the sick people walking into their emergency departments. Similar to the omicron and delta COVID-19 waves last winter that crippled emergency rooms, hospitals are currently leaning on nearby states to get medical care for patients.

This winter, capacity is especially slim for pediatric patients who are coming down with respiratory viruses.

Doctors and hospital leaders across the country warned of a “tripledemic” ahead of the holiday season. Now the warnings of high RSV, flu and COVID-19 cases are coming to fruition across the country and, in Nebraska, hospitals are once again overloaded. Hospital leaders say an influx of patients on top of the ongoing health care worker shortage are affecting the quality of care they're able to provide.

Data on flu cases from the Nebraska Department of Health and Human Services.
Data on flu cases from the Nebraska Department of Health and Human Services.

Nearly 1,500 people were admitted to emergency rooms in Nebraska last week with influenza-like illnesses. That’s an increase of 500 patients compared to the week ending Nov. 19.

The state recorded nearly 1,800 positive flu tests Nov. 27, according to the Department of Health and Human Services. That number is up from 408 positive flu tests on Nov. 5.

Local health departments report an increase in illnesses around the Thanksgiving holiday. The Lincoln-Lancaster County Health Department reported a slight increase in wastewater viruses following the holiday weekend. On Tuesday, increasing reports of illnesses and viruses in Lincoln's wastewater triggered the Lincoln-Lancaster County Health Department to bump its COVID-19 risk dial to "elevated yellow," indicating moderate spread of COVID-19 in the community.

The health department said it’s also now seeing an alarming number of flu cases this week in children ages 6 to 19.

The sharp rise of flu cases comes as hospitals are already overwhelmed with young children sick from RSV. The number of positive RSV tests are beginning to trend lower after a peak in mid-November, although hospitals are still operating with little capacity in their pediatric departments.

Eight pediatric intensive care beds were available in Omaha-area hospitals Monday. A Douglas County Health Department report released Dec. 2 detailed only five beds available with 91% of Douglas County pediatric beds full.

In the heart of Omaha, the area's Children's Hospital & Medical Center, the only dedicated children's hospital in Nebraska, is routinely hitting its capacity.

Dr. Zeb Timmons, Division Chief of Emergency Medicine at Children's, said his team is working daily with metro hospitals to get sick kids into centers that have space for them.

"Our emergency department is pretty well suited to take care of about 120 to 130 kids a day, and we've been seeing [numbers] in the 160s," Timmons said.

The hospital has also had to lean on specialized children's medical centers hundreds of miles away. Timmons said in those out-of-state transfer cases, the hospital works with families to get them transportation to facilities that may be outside state lines.

"I hate having that conversation with a family where we have to make that unfortunate choice to send them somewhere else, because they usually want to stay with us," he said. "But it's just the reality of the situation right now. There's more patients than there is space to put them everywhere in the country."

Children's Hospital is also fielding requests from overwhelmed pediatric centers that need to transfer patients to Omaha. Timmons said the hospital prioritizes local requests and children who are the sickest. If the hospital can safely send moderate cases to other hospitals that have staffed, open pediatric beds, Timmons said they'll do that to make room for more patients at their Omaha center.

In Lincoln, officials at CHI Health and Bryan Health are trying to keep as many beds open as they safely can.

“Nebraska, Kansas, Iowa and Missouri are now on regular calls to talk about a potential crisis state for pediatric care
John Trapp, Bryan Health chief medical officer

Dr. John Trapp, Bryan Health's chief medical officer, said the week following Thanksgiving, 12 of Bryan's 18 pediatric intensive care beds were full.

Trapp said one of his primary concerns is not having a pediatric care facility back-up available — such as Children’s Hospital in Omaha. Trapp said it’s led to discussions with other pediatric hospitals in the region.

“Nebraska, Kansas, Iowa and Missouri are now on regular calls to talk about a potential crisis state for pediatric care,” he said.

Trapp said the hospital has had to step in to help other states as well. Over the Thanksgiving holiday weekend, Bryan Health took in a child from the University of Iowa’s Stead Family Children’s Hospital, which didn’t have room to provide intensive care for any more children.

“This was a child who was sick enough and later required intubation – so breathing support that requires an intensive care unit,” Trapp said. “[There are] a lot of adult doctors in the state, but not as many who are comfortable with very small children.”

CHI Health St. Elizabeth's Chief Medical Officer, Dr. Jason Kruger, said his hospital has recently reached out to facilities in Denver, Kansas City and Oklahoma City to try to find intensive care for children, although the hospital hasn’t had to transfer patients just yet.

“Everything is running near capacity at this point.”
Jason Kruger, CHI Health St. Elizabeth's chief medical officer

So far, the CHI hospital in Lincoln has been able to “shuffle” patients in its neonatal intensive care units to try to find beds, according to Kruger.

“[We’ve had to] take care of patients a little sicker than what we normally do and hold onto those rather than transporting them across multiple states,” Kruger said. “Everything is running near capacity at this point.”

Each of the hospital leaders emphasized the stress particularly on their emergency rooms. They're asking families to call their children's physicians before directly heading to the hospital. They're also recommending scheduling telehealth visits and utilizing urgent care centers.