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Some community hospitals that struggle to maintain a financially viable pediatric inpatient service have found success with a model that combines their pediatric inpatient unit with a pediatric ED. The approach was developed first at Howard County General Hospital in Columbia, MD, nearly two decades ago, and has been duplicated at other community hospitals in the state. Now, community hospitals elsewhere are taking a look. In addition to the financial benefits, users of this approach say that it can improve throughput while also boosting patient and provider satisfaction. The concept involves placing the pediatric inpatient unit adjacent to the pediatric ED so that pediatric physicians and nurses can float between the two sides of the unit as needed, maximizing resources. Although the approach initially takes volume away from the adult ED, administrators say hospitals generally replace this volume within two years. Pioneers of the combined model note community hospitals must engage in at least 10,000-12,000 pediatric encounters in the ED every year for the combined pediatric inpatient unit/pediatric ED model to be successful.