Key principles for Pediatric/Neonatal Inpatient Capacity Planning in the Face of Uncertain and Volatile Future Demand, Effect of Department Size on Costs, and How to Discern if Sources of Advice Have Genuine Expertise

Pediatric/neonatal bed demand unsurprisingly depend on the trend in local births. Periods of higher births generate a capacity shock, where length of stay (LOS) is reduced, sometimes by premature discharge or transfer to another hospital, to squeeze arriving patients into existing bed capacity. Similar capacity shocks occur during the autumn/winter/spring period when volatile levels of circulating pathogens, allergens, and air quality exacerbate common pediatric conditions. In England, 30% of 1,285 pediatric ICD-10 (3-digit) diagnoses have very high year-to-year volatility in admissions, while diagnoses with >3-times higher volatility than Poisson variation account for 54% of pediatric admissions. Such enormous volatility implies that the average length of stay (LOS) plays an almost trivial role in capacity planning. It is proposed that the Wuhan and Alpha strains of COVID-19 acted to reduce pediatric demand via pathogen interference – one example of how 3000 species of known human pathogens can interact with overall health in complex ways. Simple methods are presented to: 1. Construct scenarios for future births, 2. Construct a profile of daily (volatile) bed demand across the year, and 3. Calculate the surge capacity required to cope with a worst year. The Erlang equation is used to determine the optimum average bed occupancy rate for unhindered access to a bed, which depends on the size of the unit. For example, a 10-bed unit must function at only 31% average occupancy for unhindered access. Diminishing average occupancy as size reduces explains why smaller Pediatrics units cost more to run, and how this may influence the funding for smaller units in less populated rural and remote areas. The optimum size is above 30 beds, with 10 beds the likely minimum for an effective unit. Despite having a very high number of specialist children’s hospitals, the USA only manages to rank 55th in the world for childhood mortality – higher than Russia and Romania. With 47% of pediatric units in the USA having <10 beds, this could be described as a very expensive form of chaos. It is suggested that the numerous small units in the USA are unable to deal with anything other than the simplest admissions and form a vast hidden queue to (delayed) admission via transfer to a larger unit. Suggestions are given for lowering pediatric costs in the USA by improving the economy of scale. Finally, a list of nine ‘never do this’ catastrophic pitfalls are given for doctors to identify dubious capacity advice from managers and external ‘experts’.