Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: A mixed-methods study.

BACKGROUND: During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. MATERIALS AND METHODS: We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. RESULTS: Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers' journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived "overwhelmed" NHS by speaking to trusted sources, predominantly general practitioners (GPs). CONCLUSION: Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child's health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.

Improving Care for Young People who Self Harm

AimsOur aim was to improve the quality and consistency of care given to young people who presented to our urban Emergency Department (ED) with self-harm.MethodsWe evaluated Hospital Episode Statistics to assess the number of young people presenting to our ED with self-harm over a 6 month period from 2020-2021. We distributed a questionnaire to all staff members working with young people in ED, in order to understand our current practice of support measures offered. This received 26 responses. Following this, we introduced an information pack collating relevant resources and created a website to signpost young people and their families to appropriate local and national support. We liaised closely with CAMHS and Paediatric staff to raise awareness of the information pack and ensure consistent implementation.ResultsHospital statistics showed that the number of young people presenting with self-harm increased by 30% in late 2020 and early 2021, following the initial COVID-19 lockdown. Our initial staff questionnaire highlighted that there was significant variation in practice, and that ED doctors wanted information and resources to give to young people and their carers. People were signposting to 20 different resources although 4 respondents denied signposting. We produced a paper information pack and collated resources on an easy-to-access website. CAMHS practitioners working with young people who self-harm valued the information packs and fed back that families appreciated having a guide of helpful resources to take away. This work led to the development of a guideline to provide a clear pathway of care of young people who self-harm for all health professionals to follow.ConclusionSelf harm commonly presents to the Emergency Department and cases have increased locally and nationally during the pandemic. A readily available information pack and website providing easy access to local and national resources can improve the quality and consistency of care given to young people presenting with self-harm. This project highlighted the importance of integrated care, bringing paediatric and CAMHS colleagues together to improve the care and support for young people and their families at a very vulnerable and stressful time.

Parental perceptions of paediatric emergency departmental attendance in children during the COVID-19 pandemic in UK (PPEDiC). The qualitative view

BackgroundThe COVID-19 pandemic has massively impacted on how healthcare is accessed. Paediatric Emergency Departments (PED) attendances have fallen dramatically in the UK during this period. Studies so far have focused on quantitative data when exploring this topic;whereas, our study uses qualitative methodology to review parental attendance motivations. Our study addresses a critical gap in understanding the factors that may influence caregivers’ PED attendance in the context of the COVID-19 pandemic within our region.ObjectivesThe aim of the study was to explore and understand how the COVID-19 pandemic influenced caregivers’ health-seeking behaviours. Specifically , we assessed how caregiver behaviour has changed, the perceived factors affecting presentation to the paediatric emergency department, how information around health has been received by caregivers and how the information should be communicated by health-care professionals to meet the caregivers’ needs.MethodsThis qualitative sub-study was part of a mixed method study assessing parental perceptions and experience of PED. It used a purposive and convenience sampling method to recruit caregivers attending PED with varied age, gender and ethnicity. Using in-depth interviews, we explored caregivers’ experiences and perceptions of PED attendance among caregivers who presented with their children at our trust, comprising of two hospitals, during November - December 2020. Informed written consent was obtained from caregivers. Twenty semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically using coding to identify emergent themes, patterns and concepts from participants’ accounts. The thematic content analysis was conducted by two study members for inter-rater reliability.ResultsThe findings coalesced around three main themes: caregivers’ lived experience of the pandemic, healthcare seeking perceptions and behaviour, and information sources/communication channels. When describing experiences of the pandemic, almost all participants expressed intense emotions such as fear, anxiety, depression and the need to adapt to new social norms. Decision-making around when and where to seek care for a sick child was predominantly influenced by the severity of the child’s condition, professional medical advice and perceptions of the SARS-COV-2 transmission risk posed by visiting the hospital: ‘we’ve heard … of people going into hospital for something unrelated and catching it’ID8. Some caregivers reported how hospital staff actions and/or the hospital environment itself could mitigate and/or propagate these concerns in equal measures, such as wearing masks correctly. Caregivers also expressed worries around overburdening the NHS ‘I’ll just ring the GP see what they say … make sure they (the hospital) wouldn’t think we were wasting their time’ID4. Despite the varied range of communication channels reportedly providing health information, which included government, health services, mainstream and/or social media, many participants cited distrust in one or several of these sources. Health professionals, schools and social networks were cited as trusted and preferred sources for disseminating information around paediatric health issues.ConclusionsOur findings show that caregivers are fearful of bringing sick children to PED and some mainstream sources of information are perceived to be untrustworthy. Public health messaging should emphasize the availability and safety of hospital facilities.

Parental perceptions of paediatric emergency departmental attendance in children during the COVID-19 pandemic in UK (PPEDiC). The quantitative outcomes

BackgroundSince March 2020, National lockdowns in UK to control the spread and impact of the COVID-19 pandemic have resulted in a reduction in children attending Paediatric Emergency Departments (PED) nationwide. At our Trust, there was a 46% reduction in PED attendances in 2020 compared to the same two-month period in 2019 (6631 v 12092).ObjectivesThe study aims were to analyse the impact of lockdown on PED attendance in our Trust, identify reasons for reduced attendance, drivers of change in behaviour, the clinical conditions, timing, and outcomes of PED attendees.MethodsThis quantitative sub-study was part of a prospective mixed methods study that recruited caregivers of children ≤16 years attending PEDs in our Trust during November-December 2020. A semi-structured questionnaire was used to collect data including demographics, details on reason for attendance, source and type of advice sought prior to attendance, the form of transport used to get to PED and clinical outcomes of the attendees. Likert scales were used to assess fears and drivers of change in behaviour around PED attendance. We used frequencies, proportions and Spearman’s correlation coefficient to summarize the data. Likert scale data was analysed using measures of central tendency (median) and dispersion (interquartile range).ResultsA total of 98 caregivers who attended PED with their children during the study period were recruited randomly. Most participants were female (79.6%). About 92% of the participants disclosed their ethnicity: with 57/90 (63%) were white, 19(21%) identified as black and 14(16%) were other races including people of Asian and Hispanic descent.Over 60% of participants came to PED within 2 days of illness, with mode of transport being: by ambulance (13%), drove their own cars (59%) and used public transport (13%). The commonest clinical presentation was injuries 29/98 (30%), followed by respiratory conditions 11/98 (11%). A total of 76 (78%) were discharged while 17(17%) were admitted.The main concerns related to PED attendance were;risk of contracting COVID-19(41%);and concerned about overburdening the NHS (25%). Just under half, 42/98 (43%), of participants stated that they would have attended PED in the same time frame as they did in contrast to 32/98 (32.6%) of those who felt they would have attended earlier if there was no pandemic. Whilst 22/98 (22.4%) were not worried about attending PED at all. There was no correlation between self-rated level of worry about coming to PED and time taken to PED attendance (spearman correlation co-efficient = 0.1399)Most participants 60/98(61.2%) discussed their child’s illness with another person prior to presentation. 5/98 (5.1%) of the participants were advised not come to ED but they decided to attend anyway. 28/98 (28.6%) participants contacted GPs followed by 19/98 (19%) who consulted the NHS 111 service.ConclusionsThis study demonstrates that in line with national figures, PED attendances fell dramatically during the Covid pandemic, especially in the area of respiratory illness. For the carers who brought their children to the PED, there was a high level of concern about safety and infection control for themselves and their children that needs to be addressed.