ABSTRACT
Background: The COVID-19 pandemic presented unique challenges to pediatric emergency medicine (PEM) departments nationwide. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care while keeping their workforce safe. Methods: This is a qualitative study based on semi-structured interviews with PEM physicians in leadership positions within their institution's COVID-19 response or emergency/disaster management departments. Participants were identified through convenient purposive sampling. Demographic data was captured in a pre-interview survey. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by two independent coders. Constant comparison analysis was performed until thematic saturation was achieved. Member checking was completed to ensure trustworthiness of the results. Results: Fourteen PEM-trained physicians participated in this study. Eleven of the participants received specialized disaster management training, and ten are directors of their institutions' emergency/disaster management departments. Communication, leadership and planning, clinical practice, and personal adaptations were the principal themes identified. Within these themes, participants discussed challenges and offered examples as to how they overcame them within their department and their larger institution. To improve communication and disseminate new information, departments might consider shift huddles, town hall meetings, limiting the number of daily emails, and highlighting the newest changes. During traumas and resuscitations, “gatekeepers” oversee who goes into the trauma bay, and technology should be utilized to communicate with the team outside. For leadership and planning, the emergency department should appoint leaders to summarize updates and attend incident command meetings. Institutions should consider developing containment units and having multiple vendors for key supplies as part of their pandemic plans. Business continuity plans should be updated regularly as part of pandemic preparedness. Hospitals should be prepared to utilize telehealth and accept adult patients if pediatric volumes drop. Recommendations regarding adjusting clinical practice include having clear guidelines for what constitutes an aerosol-generating procedure, drive-through testing sites to alleviate pressure on emergency centers, and performing triage in the patient's room if possible. Personal protective equipment (PPE) should be safely re-purposed if supplies are insufficient. Staff must be trained on the proper donning and doffing of PPE with regular reminders during prolonged pandemics. Transparency with the workforce regarding supplies, testing, and safety protocols help alleviate fear and anxiety. Medical caregivers can limit their exposure by utilizing cardiac monitors visible from outside patient rooms and providing updates via telephone in patient rooms. For a full list of challenges and recommendations, see Table 1. Conclusion: By sharing COVID-19 experiences and offering solutions to commonly encountered problems nationwide, pediatric emergency centers and their institutions may better prepare both themselves and one another for future pandemics.
ABSTRACT
Purpose/Objectives: Deficiencies in day-to-day operational readiness are exacerbated during a disaster, disproportionately affecting children. Two 6-month long initiatives were piloted to recognize deficient areas of preparedness and create change strategies to address preparedness for disasters in both pediatric clinics and hospitals. We demonstrate that a physicianled, QI-based approach is an effective strategy to enhance pediatric clinics and hospitals disaster preparedness. Design/Methods: Pediatric considerations were divided into seven domains (Figure 1 and Figure 2), each domain delineated primary drivers, change strategies, and resources to minimize knowledge barriers and drive improvement. After completing initial quality improvement education, physicians scored their plan in each of the domains using a 6-point scale (max. score 42 pts.). This environmental scan intended to evaluate deficiencies in the participant's disaster plan. Physicians conducted 4 meetings over the course of 6 months to review improvement strategies. Teams repeated the environmental scan monthly, aiming to achieve at least a 2-point increase per domain or a total score of 30 by the end of the 6 months. Upon completion of the project, participants were eligible for 25 Maintenance of Certification Part 4 credits. Results: The clinic-based initiative was led from January 1 - June 30, 2020 with 11 registered physicians. The median overall preparedness score increased from 18 (IQR=11.5;n=11), to 38.5 (IQR=6;n=4) at the conclusion of the project, an overall 48.81% (42.86% to 91.67%) increase in total preparedness. The hospital-based initiative was led from June 30 - December 31, 2020 with 71 registered physicians. The median overall preparedness score increased from 14 (IQR=12.5;n=7) to 33.5 (IQR=10.25;n=12) by the conclusion of the project, an overall 46.43% (33.33% to 79.76%) increase in total preparedness. Conclusion/Discussion: The COVID-19 pandemic affected participation in the project as many participants were tasked with additional duties at their institution. Nonetheless, this model of physician-led preparedness efforts proved to be a successful strategy for improving disaster preparedness of both pediatric clinics and hospitals. Clinic-based physicians focused on vaccine storage. Some purchased generators to ensure safe vaccine storage while others worked with their local hospital pharmacy to store vaccines in the event of a disaster. Others moved their electronic medical records to cloud storage. The hospital-based physicians identified staff education and communication as the most useful domains. This was closely followed by surge planning, many of which were immediately tested by the current pandemic. Others highlighted efforts to improve patient-centered care by improving coordination with social work, administrators, and chaplains to meet patient needs. The next cohort for both the clinic-based and hospitalbased initiatives will be launched late summer or early fall 2021. In anticipation of large pediatric COVID-19 vaccination efforts, these cohorts will have a heightened focus on vaccine storage and mass pediatric vaccination strategies.