Growth spurt: A big expansion in pediatric care

Earth is being moved, walls are coming down, and pipes and wires are being ripped out at scores of children's hospitals across the nation.

It's not a sign of an apocalypse in pediatric care. Rather, these hospitals are undergoing massive renovation and expansion projects. They are part of a boom in construction at children's hospitals that has been gaining momentum for a couple of years and hasn't showed signs of slowing.

The examples are too numerous to list. From Las Vegas to New Orleans to New York, pediatric facilities are spending tens of millions of dollars to add beds, surgical suites, family centers, more private rooms and expanded ambulatory services.

Observers say several factors could be combining to fuel the trend. First, many existing facilities are older and need to be updated to accommodate new technology and the evolving ways that care is provided. Next, many hospitals are seeking to redesign themselves to better serve the needs of patients' families. From a market standpoint, children's hospitals might be getting a larger portion of child admissions as pediatric wards at general hospitals shrink. Finally, a surge in overall hospital construction could be resonating in children's hospitals as well.

For family physicians, pediatricians and pediatric specialists, the implications of the building boom are obvious. They will have enhanced and expanded facilities for treating their patients. And there could be greater demand for subspecialists -- some of whom are already in high demand -- to staff those facilities. But the potential effects on other physicians are worth noting as well.

"The average pediatrician and general practice physician doesn't admit that many patients in any given period of time. But certainly having the assurance that high-quality pediatric services are accessible to their patient population would be comforting," said Lawrence McAndrews, president and CEO of the National Assn. of Children's Hospitals and Related Institutions (NACHRI).

McAndrews said one of the main factors driving the building boom is that children's hospitals are getting a larger share of a shrinking market.

"There are fewer kids being admitted, because routine care is being treated on an outpatient basis," he said. "The simpler care that used to be admitted into community hospitals has been stripped out. So when a child is sick and needs to be an inpatient, they are more likely to need the services of a children's hospital."

This idea is supported by statistics from NACHRI, which found that between 1995 and 2000 the number of children admitted to all hospitals dropped by 3%, and the number of hospitals offering pediatrics dropped by 3%. But during the same period, admissions to children's hospitals increased by 10.5%.

The organization, which has about 165 member institutions, estimates that there are about 250 children's hospitals in the United States, making up less than 5% of all hospitals. Many of the pediatric facilities are connected to larger hospitals. McAndrews said the number of freestanding children's hospitals has remained fairly constant at roughly 45.

Pent-up demand

The surge in construction at children's hospitals might reflect a broader trend of what is happening at all types of hospitals. Lewis Redd, national practice leader for the consulting firm Capgemini Health, said a lot of hospitals had put off building projects in the 1990s because of financial stress. Now, he said, some of those projects can't be put off any longer, so there's an uptick in construction.

Rick Wade, senior vice president of the American Hospital Assn., said hospitals across the board were seeing a building boom largely because many facilities are old and outdated.

"We have an awful lot of hospitals in this country that are reaching the end of their useful life," he said, adding that many had been built just after World War II. "A lot of these institutions have been remodeled and added onto for years. But when you think about how we deliver care these days, it's so radically different, it needs to be rebuilt."

He expects the trend to persist for at least a few years while these building projects catch up with hospitals' needs. "I think you'll see it going for the next three to five years, and then it will level. ... Then there will be another slack period and then another cycle of building," he said.

The age of the University of Chicago Children's Hospital was a driving factor in its decision to build a $130 million facility, due to open at the end of 2004. The original building, which opened in 1967, had started to show signs of its maturity. The facility "was getting tired and getting toward the end of its useful life. The cost of renovating the structure was very high. It was deemed more efficient to construct a new children's hospital," said Herbert T. Abelson, MD, a professor of pediatrics at the University of Chicago.

With the new facility, the hospital is expanding from 95,000 square feet and 140 beds to 242,000 square feet and 155 beds. There will be a new pediatric emergency department with an additional 22,000 square feet as well as a new surgery suite, a new cardiac surgery intensive care unit, enhanced education facilities, larger private rooms and more. And to be sure, the new building will be wired to handle the types of technology that weren't around in 1967.

"It's enhanced in virtually every way," said Dr. Abelson.

Patient volume also could be a driving factor in the construction boom. Sunrise Children's Hospital in Las Vegas decided to embark on an $80 million construction and renovation project to accommodate population growth in the region, said James Swift, MD, a pediatric critical care specialist and medical director of the hospital. In fact, Dr. Swift said many children's hospitals lacked an adequate number of beds.

"For the longest time, we have been under-bedded for pediatric beds. The focus [recently] is on the aging baby boom generation, but I think we're still seeing the tail end of that generation having children. ... This [trend] is probably catching up with what has been a need for beds."

With the expansion, Sunrise will jump from 120 pediatric beds to 195. The project is expected to be completed in fall 2006.

Acute care responsibilities

Dr. Abelson said he had observed a shift in the way children's hospitals are now being designed to reflect that they are seeing a larger percentage of acute cases as other patients are increasingly treated in ambulatory settings.

"Children's hospitals are evolving into giant intensive care units surrounded by ancillary services," he said, adding that intensive care units are becoming larger percentages of the total hospital beds.

Indeed, that will be the case at Le Bonheur Children's Medical Center in Memphis, Tenn., if its board approves a $200 million project to nearly double its size from about 649,000 square feet to a little more than 1 million square feet.

Peggy Troy, RN, president of the freestanding hospital, said the proposal would change the mix of beds to include more intensive care beds. But because the pediatric population in the area is fairly stable, the new facility would add only about 30 beds.

The new facility would have enhanced technological capabilities and more room for equipment. It also would have expanded ambulatory services to meet the needs of children's health care, Troy said.

But McAndrews said there also had been significant interest in building more outpatient services at children's hospitals. The projects might include new physician office space, an ambulatory surgery center or other kinds of ancillary services, he said. "It's so the patient can come into a single setting and get all that they need," he said.

Some children's hospitals also could be building so they can showcase more specialized types of care such as pediatric cardiology. McAndrews said that although there hadn't been a dramatic surge in the number of new pediatric subspecialties in the last few years, there might be more awareness about them.

Indeed, consumer awareness and demand could be driving some of the building trend as well. All of the children's hospitals contacted by AMNews for this story said they were hoping to increase their emphasis on family-focused care with their new building projects -- something that parents have sought.

To meet the needs of patients' families, children's hospitals are beefing up the number of private rooms that they have, expanding those rooms so family members can sleep there, providing laundry and business services for parents, play rooms for siblings and more.

"All children's hospitals realize that children feel safer if their parents are with them," said John Baldwin, vice president of facilities planning and development for Children's Healthcare of Atlanta, which has proposed spending $344 million to expand its two inpatient hospitals from a total of about 756,000 square feet and 430 beds to about 1.26 million square feet and 500 beds. Though almost all of the hospitals' rooms are private, Baldwin said the expansion would add to the concept of family-centered care by enhancing its family amenities and including more sleeping spaces.

So where are hospitals getting the money to pay for these new facilities? McAndrews said investor ratings services tend to look more kindly on children's hospitals than general acute-care facilities, meaning a lower interest rate on construction bonds. He said parents also might play a role in facilitating the construction through philanthropy.

Still, McAndrews said the money for all this construction is bound to run out soon. And when it does, the building boom will wind down. "There are so many children's hospitals that have projects in," he said. "In all likelihood, for the lack of cash, it's got to start slowing down."