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Inpatient capacity constraints have been a pervasive challenge for hospitals throughout the COVID-19 pandemic. The Mayo Clinic Health System - Southwest Minnesota region primarily serves patients in rural southwestern Minnesota and part of Iowa and consists of 1 postacute care hospital, 1 tertiary care medical center, and 3 critical access hospitals. The main hub, Mayo Clinic Health System in Mankato, Minnesota, has a pediatric unit with dedicated pediatric hospitalists. To address the growing demand for adult inpatient beds at the height of the pandemic, the pediatric unit was opened to allow adult patients to be admitted when necessary. For several months, adult inpatient capacity exceeded 90%, which decreased the number of available pediatric (vs adult) beds throughout Minnesota, particularly in rural communities. Data for the health system showed that children were most affected because transfers to the next available hospitals for pediatric cases were 55 miles away or more. To address this gap, the hospital team successfully trialed a pediatric bed prioritization guideline that reduced pediatric transfers by 40%. This was accomplished by prioritizing the last remaining inpatient bed on the pediatric unit for pediatric patients only. This process not only reduced pediatric transfers but also increased unique patient admissions because of an average lower length of stay for pediatric patients compared with adult patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)