“Doctors have to call for hours to place the children elsewhere”

Dthe cold season has begun, oncology and neurological patients must be cared for – but many nurses are sick, working part-time or even retired. Therefore, the situation in intensive care units for children is currently very tense. Professor Ursula Felderhoff-Müser, vice-chairman of the German Society for Pediatric and Adolescent Medicine, on the situation in German children’s hospitals.

Is there acute overcrowding in the pediatric intensive care unit?

When we talk to colleagues, there is hardly a pediatric intensive care unit that does not regularly have to close beds due to staff shortages. And we actually have the problem of doctors who are actually needed at the bedside spending hours on the phone with ICUs all over the area to accommodate the children elsewhere. We also have to transfer children to clinics up to 200 kilometers away. It is obviously very difficult for families when the child is in intensive care and is so far away from home.

Can you be more specific how many beds are locked?

This varies from region to region, but it can happen that a third or even half of the beds in a clinic cannot be occupied. The situation will continue to worsen in the cold season because the period of infection begins again. In the summer, there was not really much relaxation in terms of the number of patients.

Also because of Covid?

No, it has nothing to do with the pandemic, children rarely need to be hospitalized if they are infected. There are several other infections, respiratory infections – but also children with acute life-threatening illnesses such as serious accidents, diseases of the nervous system or oncological diseases. Although these are less common than in adults, it is important that children are adequately looked after. Clinics that offer maximum intensive care – for example, dialysis or neuromonitoring – in pediatrics are in particular demand.


Pediatrician Ursula Felderhoff-Müser from the children’s clinic at the University Hospital in Essen.
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Image: Hojabr Riahi

Can children also be treated in adult intensive care units if necessary?

This is by no means an alternative for all children, it is only possible for older children or young people. And there must be a vacant place in the adult ward, of course the situation there is also tense. With, for example, small children or infants, who have completely different needs, it is not possible anyway.

What is the biggest problem?

Lack of staff in the care sector is the main reason at the moment because we have a very reduced number of pediatric intensive care beds. However, we have observed this trend for years, and of course it has not improved during the pandemic, as many nurses have given up their jobs.

Does the worsening situation also have something to do with the reform of nursing education?

In fact, we fear that pediatric nursing as a specialization subject starting with general studies (Note to the editors: what is meant is the general nursing education, which was passed in the Nursing Professions Act in 2021) is no longer explicitly offered. Nursing is such a beautiful job.

what is going to happen

We have an urgent need to recruit more nursing staff and make the profession more attractive again. This applies to adult care, but especially care within paediatrics. During the pandemic, a little of the fact that pediatric nursing is a really fine profession has been lost. And of course, relatives must be valued appropriately and paid fairly. This is a step that should have been taken a long time ago.

And on a political level?

We need more financial resources, especially in paediatrics, where we have very high upfront costs, i.e. the costs that are not included in the current fixed rates, i.e. the flat rates used to bill medical services in Germany. Children’s hospitals often do not work financially. The minimum staffing is also not up for discussion, but there are simply not enough staff. To draw blood from a small child, you need a doctor and two nurses and a certain amount of time to convince them that you can draw blood at all. With an adult, it is of course something completely different.

So the fixed system itself is not the problem?

We must sufficiently reimburse the case-based fixed rates and include the delivery costs. When the case-based system was introduced, it was not sufficiently taken into account that children have completely different needs. As already mentioned, many things require significantly more personnel and technology than in adult medicine, as children, for example, must be monitored very closely. And sometimes it takes a lot of detective work to find out what is really wrong with the child. The case-based flat rate system simply does not reflect this at the moment.

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