ABSTRACT
BACKGROUND AND AIM: An eight-bed adult COVID-19 critical care (CC) unit was established within our pediatric intensive care unit (PICU) when SARS-CoV-2 variants increased CC bed demand. Our objective was to rapidly roll out electronic order sets (OS) to facilitate computerized provider order entry (CPOE) for adult patients admitted within a children's hospital. METHOD(S): OS development began from the assessment of OS from seven adult CC units. Using a pre-existing PICU Admission template, we created two OS: adult COVID-19 admission and on-going care. We tested the prototypes in a multidisciplinary onsite-virtual hybrid tabletop simulation to evaluate usability within established workflows. Participants utilized role-specific profiles within the electronic medical record (EMR) training environment which paralleled their computer interface, permitting charting and documentation. EMR analysts were present to gather change requests. Following implementation, we performed twice daily hot debriefs with end-users to further identify issues. RESULT(S): 16 multidisciplinary bedside providers participated in simulation testing of the prototypes. Two safety issues were addressed before implementation. The electronic OS were developed, tested, and implemented within 8 days. The post-implementation hot debriefs identified one medication addition, and no deletions were necessary. CONCLUSION(S): Caring for adult COVID-19 patients within a freestanding children's hospital presents challenges and has the potential to introduce latent safety threats. Rapid development and implementation of electronic OS within 8 days to facilitate CPOE and reduce healthcare provider cognitive burden relied on leveraging functionality within the EMR system, performing iterative testing with a tabletop simulation, integration into previously established workflows, and gathering post-implementation feedback for continuous improvement.
ABSTRACT
BACKGROUND AND AIM: Worldwide health systems have been strained by the COVID-19 pandemic. Surging numbers of critically ill adult patients demanded urgent system-wide responses. Our Paediatric Intensive Care Unit (PICU) underwent a care delivery model redesign and rapid shift in processes and resources to care for critically ill adults at the peak of the pandemic. We describe novel adaptions made to accommodate adult patients for the first time in this paediatric setting. Personal insights of clinical staff, leaders and adult care partners about the experience of caring for critically ill adult patients are shared. METHOD(S): Program components included;preparation, education, collaboration (both interprofessional and interorganizational), continuous process improvement, and staff well-being initiatives. Interprofessional team impacts gathered during the implementation phase of the program and 10 months following were analysed using Havelock's Theory of Change framework1. RESULT(S): The Adult COVID-19 program facilitated rapid team capacity building and supported responsive care for adult patients. Over 12 weeks, 35 adults (426 patient days) received care in the PICU. Staff acknowledged;1] the burden of providing high quality care for adults, 2] the opportunity for individual and team growth and 3] guiding paediatric principals of strength-based, family-centered care enhanced the quality of care provided and provider perceptions of accomplishment. CONCLUSION(S): This program facilitated a rapid transformation and expansion in models of care and processes, successfully enhanced the team's capacity to deliver quality evidence-based service to adults with COVID-19 and was a source of personal growth and meaning for the health care team.