Emergency room parking lot (Photo credit: Jennifer Tran/ UNC Media Hub)

Ashley Quincin via UNC Media Hub

Two years ago, then-10-year-old Lee Fitch was riding his bike on Laurel Hill Road in Chapel Hill when he was struck by a vehicle. The accident broke his ribs, back and skull. 

Heavily medicated and suffering from a severe traumatic brain injury, Lee was placed in a three-day medically induced coma at UNC Children’s pediatric intensive care unit. Lee’s parents, Meredith and David Fitch, feared the worst.

“At that point, we didn’t know if he was alive or not going to make it,” Meredith Fitch said.

The first thing Lee spoke about when he woke up was baseball. Fitch said after that, he was moved from the PICU to the pediatric floor where there was an influx of physical, speech and occupational therapists to help Lee recover – until the Fitches were told that UNC Children’s did not have the resources to continue Lee’s inpatient rehabilitation. 

“That was what we needed,” Fitch said. “We were shocked, completely shocked. We thought that UNC Children’s did it all.”

Fitch said they were told Atrium Health Levine Children’s Hospital in Charlotte offered inpatient rehabilitation services, but the hospital’s inpatient beds were already full. Children’s National in Washington, D.C. recommended that the family not come to that hospital because half of their inpatient facility was not functioning normally due to COVID-19. 

Eventually, the Fitches traveled by ambulance to Atlanta, where Lee stayed for many months to recuperate in a medical center with 29 beds.

Limited space for pediatric care

The Fitches’ story is one example of the overcapacity that pediatric departments across the country, especially in North Carolina, are experiencing, causing many parents to travel out of state to receive pediatric care for their children.

According to a UNC Health October 2023 study, the number of hospitals in the U.S. providing inpatient care for children has decreased over the last decade, and many of them struggled to keep up with the demand for children’s care during a viral illness surge in late 2022.

The study also found an increase in the number of children who were transferred from one hospital to another before their discharge. This interfacility transfer rose from 6.1% in 2000 to 18.8% in 2019.

Dr. Benny Joyner, chief of UNC Children’s PICU and vice chair for clinical operations for the UNC Department of Pediatrics, said the need for children’s inpatient care fluctuates throughout the year. He said with winter and early springtime, for example, comes a rise in respiratory and gastrointestinal issues. 

As a result, overcapacity is at its worst during these particular months, while inpatient beds remain mostly empty during others. 

“Should we have either a broad distribution of resources throughout the state, or should we concentrate those resources?” Joyner said. “That’s always been a question.”

Another contributor to overcapacity in pediatric units is worsening mental health, exacerbated by the pandemic, Dr. Stephanie Duggins Davis, chair of the Department of Pediatrics and physician-in-chief of UNC Children’s, said. 

“We’ve seen an increase in children and adolescents who are struggling with mental health issues, who are suicidal,” she said. “That has also led to an increase in our capacity here and an increase in children and adolescents boarding.”

To address this, UNC Health and the N.C. Department of Health and Human Services collaborated to open UNC Hospitals Youth Behavioral Health in 2023, a 54-bed facility in Butner, North Carolina that will provide acute hospital care for children and teens in psychiatric crisis. 

The facility will treat more than 800 children and teens a year, according to a UNC Health press release, and prevent them from waiting for hospital emergency departments to begin specialized psychiatric treatment.

Duggins Davis said UNC Hospitals began offering telehealth options for patients across the state a few years ago because of the pandemic, especially helpful now in rural communities where in-patient pediatric units have been eliminated.

“That has really become critical because pediatric floors in many of these communities’ hospitals have closed, frankly due to financial reasons,” she said. “And because those floors are closed, many of the children are sitting in the emergency room.”

UNC Health Wayne, a nonprofit hospital affiliate of UNC Health located in Goldsboro, eliminated its inpatient pediatric care in January. Although UNC Health Wayne will no longer accept pediatric admissions, patients will be treated in a designated area of the ED until they are well enough to be discharged or transported to another hospital – including UNC Children’s – for a higher level of care.

UNC Rex Hospital in Raleigh closed its pediatric unit in 2022. The hospital announced that because of the overwhelming need for adult beds and the low number of pediatric patients needing care, it would transform its 10 pediatric beds into adult beds.

Beth Cosgrove, clinical assistant professor at the UNC School of Nursing and former nurse practitioner at Children’s National in D.C., said overcapacity doesn’t just affect patients but also strains ED resources and staff. The combination of respiratory viruses, COVID-19, influenza and pediatric mental health issues in the fall of 2022 and early 2023 resulted in an unprecedented surge of children visiting the ED.

UNC Children’s had to increase bed space, nursing staff and physicians in the ED to accommodate an increase in patients, both for mental health issues and other illnesses, Duggins Davis said.

Addressing the shortage

With North Carolina’s continuing strong population growth, in September UNC Health announced plans for a new N.C. Children’s Hospital with an initial investment by the state of $320 million.

“North Carolina is the largest state in the country that doesn’t have a freestanding children’s hospital with care aimed specifically at young patients,” Alan Wolf, director of local news and issues for UNC Health, said in an email. “Given our state’s growing population, UNC Health wants to meet that need.”

Although the hospital is still in the early planning stages, UNC Health expects the 300-acre campus will have around 500 beds with another 100 behavioral health beds. It is also anticipated that the new hospital will have a children’s ED, though some of the children’s emergency services will remain at the main campus in Chapel Hill.

Duggins Davis said the new hospital might also include an outpatient facility, a research institute and hotels nearby for families. UNC Health is currently in the process of philanthropic fundraising to sustain the $3 billion-plus project and choosing a location site – Duggins Davis said one of the state’s requirements for the hospital is that it be located in the Triangle.

A location near a major transportation hub is probable, Joyner said.

“Instead of people leaving the state to receive care, hopefully, people will come into the state to receive care from our surrounding states, from across the nation and from across the world,” he said.

In the meantime, Joyner said UNC Children’s is expanding the PICU to 36 beds and the neonatal ICU to 74 beds to ease short-term capacity concerns. The hospital is also expanding its telehealth care and increasing the number of specialists.

“As we get ready to move into the children’s campus, the most important thing for us here right now is to increase capacity and keep treating children as close to home as we can,” Duggins Davis said.

‘Closer to home’

Fitch said her family faced many challenges traveling so far for Lee’s care. Although Lee made an incredible recovery, Fitch’s then-12-year-old daughter Virginia felt that she had to step in and take over the household while her parents were at the hospital. This is something that forever changed the family and their relationships.

“That’s why we must have an inpatient rehab closer to home,” Fitch said.

After returning to their home in Chapel Hill, the Fitches were informed that some donors wanted to provide seed funding to build a pediatric inpatient rehabilitation program. The donors, UNC Football Coach Mack Brown and Sally Brown, provided the financial foundation for the Fitch Family Comprehensive Pediatric Rehabilitation Program.

Over the last three years, Fitch said the program has raised over $4 million for inpatient and outpatient services across the entire spectrum of care.

“With the new children’s hospital that’s going to be built in eight to 10 years, we hope, if not sooner, the pediatric rehab will be part of that new hospital,” Fitch said. “We’re just elated that that’s going to happen.”