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Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States.
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MedLine Citation:
PMID:  21888795     Owner:  NLM     Status:  MEDLINE    
Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.
Marion R Sills; Matthew Hall; Evan S Fieldston; Paul D Hain; Harold K Simon; Thomas V Brogan; Daniel B Fagbuyi; Michael B Mundorff; Samir S Shah
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Emerging infectious diseases     Volume:  17     ISSN:  1080-6059     ISO Abbreviation:  Emerging Infect. Dis.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2012-02-23     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  9508155     Medline TA:  Emerg Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1685-91     Citation Subset:  IM    
University of Colorado School of Medicine, Aurora, CO 80045, USA.
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MeSH Terms
Bed Occupancy / statistics & numerical data*
Child, Preschool
Hospitalization / statistics & numerical data*
Influenza A Virus, H1N1 Subtype*
Influenza, Human / epidemiology*
United States / epidemiology
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Emerg Infect Dis
Journal ID (iso-abbrev): Emerging Infect. Dis
Journal ID (publisher-id): EID
ISSN: 1080-6040
ISSN: 1080-6059
Publisher: Centers for Disease Control and Prevention
Article Information

Print publication date: Month: 9 Year: 2011
Volume: 17 Issue: 9
First Page: 1685 Last Page: 1691
ID: 3320222
PubMed Id: 21888795
Publisher Id: 10-1950
DOI: 10.3201/eid1709.101950

Inpatient Capacity at Children’s Hospitals during Pandemic (H1N1) 2009 Outbreak, United States Alternate Title:Inpatient Capacity at Children’s Hospitals
Marion R. Sills
Matthew Hall
Evan S. Fieldston
Paul D. Hain
Harold K. Simon
Thomas V. Brogan
Daniel B. Fagbuyi
Michael B. Mundorff
Samir S. Shah
Author affiliations: University of Colorado School of Medicine, Aurora, Colorado, USA (M.R. Sills);
Children's Hospital Colorado, Aurora (M.R. Sills);
Child Health Corporation of America, Shawnee Mission, Kansas, USA (M. Hall);
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA (E.S. Fieldston, S.S. Shah); Children's Hospital of Philadelphia, Philadelphia (E.S. Fieldston, S.S. Shah);
Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA (P.D. Hain);
Emory University School of Medicine, Atlanta, Georgia, USA (H.K. Simon);
Children's Healthcare of Atlanta, Atlanta (H.K. Simon); Seattle Children’s Hospital, Seattle, Washington, USA (T.V. Brogan);
University of Washington School of Medicine, Seattle (T.V. Brogan);
The George Washington University School of Medicine, Washington, DC, USA (D.B. Fagbuyi);
Children's National Medical Center, Washington (D.B. Fagbuyi);
Intermountain Healthcare, Salt Lake City, Utah, USA (M.B. Mundorff)


Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at; (4) view/print certificate.

Release date: August 23, 2011; Expiration date: August 23, 2012

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Compare the 2009 H1N1 influenza pandemic with past influenza pandemics
  • Evaluate the occupancy of children’s hospitals in the United States during the 2009 H1N1 influenza pandemic
  • Analyze the relative effects of the 2009 H1N1 influenza pandemic on emergency departments and inpatient services
  • Distinguish the number of additional admissions required in 2009 to push the children’s hospital system to full capacity.


Karen Foster, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Karen Foster has disclosed no relevant financial relationships.


Charles P. Vega, MD, Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.


Disclosures: Matthew Hall, PhD; Evan S. Fieldston, MD, MBA, MSHP; Paul D. Hain, MD; Thomas V. Brogan, MD; and Michael B. Mundorff, MBA, MHSA, have disclosed no relevant financial relationships. Marion R. Sills, MD, MPH, has disclosed the following relevant financial relationships: received grants for clinical research from Agency for Healthcare Research and Quality. Harold K. Simon, MD, MBA, has disclosed the following relevant financial relationships: received grants for clinical research from Baxter International Inc. (rehydration clinical trial); AspenBio Pharma, Inc (appendicitis screening); National Institutes of Health (progesterone planning trial through the Pediatric Applied Research Network), all through Emory University. Daniel B. Fagbuyi, MD, has disclosed the following relevant financial relationships: owns stock, stock options, or bonds from Medco Health Solutions, Inc.; Orexigen Therapeutics, Inc. Samir S. Shah, MD, MSCE, has disclosed the following relevant financial relationships: received grants for clinical research from National Institutes of Health; Agency for Healthcare Research and Quality; Robert Wood Johnson Foundation.


Suggested citation for this article: Sills MR, Hall M, Fieldston ES, Hain PD, Simon HK, Brogan TV, et al. Inpatient capacity at children’s hospitals during pandemic (H1N1) 2009 outbreak, United States. Emerg Infect Dis [serial on the Internet]. 2011 Sep [date cited].

Article Categories:
  • CME
Article Categories:
  • Research
Article Categories:
  • Research

Keywords: Keywords: hospital bed capacity, influenza A virus, (H1N1) subtype, pandemic (H1N1) 2009, child, pandemic, United States, viruses, research.

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