Final Outcomes of a Pediatric Surge-in-Place Model during the Coronavirus Disease 2019 Pandemic.

To the Editor:

We reported our hospital's approach to “surge-in-place,” where pediatric providers and nurses cared for adults with coronavirus disease 2019 (COVID-19) in a 40-bed unit within a children's hospital. We leveraged our existent quality and safety infrastructure to rapidly create and run this unit within our integrated healthcare system. Final outcomes of our first 100 patients were unavailable at article submission. Reporting these outcomes is important to understand whether our strategy resulted in similar outcomes as adults treated in traditional clinical settings.

Ninety patients were discharged: 83 (92%) to home and 7 (8%) to long-term care facilities. Ten patients died in the hospital. The total cohort's median length of stay (LOS) was 5 days (IQR 2-9). Of the surviving patients, 8 (8.9%) had a 30-day emergency department visit, 4 (4.4%) had a 30-day readmission, and 1 (1.1%) had a 30-day mortality.

Compared with a large New York City cohort, of whom 46% had available outcome data, we had a greater overall discharge rate (90% vs 79%), lower in-hospital mortality (10% vs 21%), and similar LOS (5 [IQR 2-9] vs 4 [IQR 2-7]). Our mortality rate was substantially less than nationally reported data (20.3%). Compared with patients in our own healthcare system, we had a lower mortality rate (10% vs 15.5%) and similar LOS. These disparate mortality rates are not surprising, as we intended to admit younger, healthier patients. With readmission rates ranging from 2.2% to 4.5%, our rate of 4.4% is not markedly different.

Patients hospitalized with COVID-19 on our unique unit experienced similar outcomes to what the literature reports. For healthcare systems deciding how to allocate pediatric resources to meet the care demands of adult patients during a healthcare crisis, these data support a “surge-in-place” model.