How suboptimal consolidation of care during the COVID-19 pandemic can teach us to do better.

The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching impact on medical care in the United States. Over the past year, local spikes across many regions in cases requiring hospitalization led to significant resource scarcity. Given that the most severe cases of COVID-19 resulting in hospitalizations and deaths have been primarily in adults, multiple organizations, such as the Children’s Hospital Association, the American Academy of Pediatrics, and the Association of American Medical Colleges, recommended, in the setting of resource scarcity, preferentially transferring children who require hospital care from general hospitals to dedicated pediatric hospitals.1 The consolidation of pediatric care in dedicated children’s hospitals could not only serve to optimize resource use during the pandemic crisis but also promote regionalization of pediatric care to centers with subspecialty pediatric expertise. In this issue of Hospital Pediatrics , Clark et al2 report their work examining whether the suggested pediatric consolidation occurred. They compared new admissions (defined as no admission within the previous 3 years) to children’s hospitals during 2 time periods, one prepandemic and one during the early months of the US pandemic. What they found was nuanced. Overall admissions to children’s hospital significantly decreased during the pandemic time period compared with prepandemic levels. There were different patterns of discharge diagnoses during the 2 study periods. An admission encounter was more likely to be a new patient during the pandemic time period, but the frequency of new patient encounters did not differ between study periods after accounting for discharge diagnoses. After categorizing hospitals by rate of local COVID-19 incidence, children’s hospitals in areas of medium and high COVID-19 transmission had increased odds of experiencing a new patient encounter. All this suggests that there were changes in pediatric hospitalizations …