In the mid-1990s, David Monroe, MD, a pediatrician in Columbia, Maryland, remembers having to admit children with common diagnoses such as appendicitis, asthma, and pneumonia to hospitals 30 or more miles away. That was because Howard County General Hospital, the community hospital in Columbia, was struggling to maintain pediatric inpatient care.
“We tried to find a way to keep patients closer to families, keep them in our community, and still deliver good quality pediatric care,” says Monroe, an assistant professor of pediatrics at Johns Hopkins, Baltimore, Maryland, and director of the Children’s Care Center at Howard County.
Like many community hospitals nationwide, Howard County couldn’t financially justify staffing a dedicated pediatric inpatient unit with pediatric nurses because of the unpredictable and variable nature of pediatric patient flow. Winters were busier, but summers were slow. Sometimes, according to Monroe, there weren’t any patients filling those beds.
This is still a common problem today. Most community hospitals that have pediatric coverage must subsidize this care, according to Monroe.1
The pediatrician created a model to make the inpatient side viable by combining the pediatric emergency department (ED) with a pediatric inpatient unit, and having one staff to run both. Monroe says he figured the 5000 pediatric emergency visits the hospital had a year would drive the combination unit’s financial and staffing viability. Pediatric nurses would stay because they’d be working with only pediatric patients, and more parents and caregivers would bring their children for emergency care and inpatient care to Howard County because of the specialized approach, he predicted.
He was right. The combined unit opened at Howard County in 1997. Since then, Monroe, considered the model’s founder, has published on the concept.1
“What we found was, first, the hospital was happy because we were viable. The unit supported the full salaries for nurses and physicians, from year one all the way to now. It continues to be on the national patient satisfaction scores—if not the highest-ranking unit in the hospital, one of the highest-ranking units in the hospital. We started with 5000 patients [a year in the ED]; we’re now a little over triple that at 16,000 patients,” Monroe says.
Deliveries also have increased at Howard County, which makes sense, according to Monroe. “[It is known] that the moms often decide where the whole family gets care for every problem. So, if the moms are happy with pediatric care, they’re more likely to go to the same hospital for all their care. If the moms are happy with their delivery care, they’re more likely to come here for pediatric care,” Monroe says.
The combined unit at Howard County has been profitable for 13 to 15 years. The largest loss was $9000 out of a $2 million budget. The largest annual profit: $100,000. The losses have occurred in the last 2 years. An explanation for that, according to Monroe, could be an increasing number of local urgent care centers. “One of the nice things about the model is it’s flexible, so we’re adjusting the staff,” Monroe says.