ABSTRACT
BACKGROUND: Family-centered rounds (FCR) are fundamental to pediatric inpatient care. During the COVID-19 pandemic, we aimed to design and implement a virtual family-centered rounds (vFCR) process that allowed continuation of inpatient rounds while following physical distancing guidelines and preserving personal protective equipment (PPE). METHODS: A multidisciplinary team developed the vFCR process using a participatory design approach. From April through July 2020, quality improvement methods were used to iteratively evaluate and improve the process. Outcome measures included satisfaction, perceived effectiveness, and perceived usefulness of vFCR. Data were collected via questionnaire distributed to patients, families, staff and medical staff, and analyzed using descriptive statistics and content analysis. Virtual auditors monitored time per patient round and transition time between patients as balancing measures. RESULTS: Seventy-four percent (51/69) of health care providers surveyed and 79% (26/33) of patients and families were satisfied or very satisfied with vFCR. Eighty eight percent (61/69) of health care providers and 88% (29/33) of patients and families felt vFCR were useful. Audits revealed an average vFCR duration of 8.4 min (SD = 3.9) for a single patient round and transition time between patients averaged 2.9 min (SD = 2.6). CONCLUSION: Virtual family-centered rounds are an acceptable alternative to in-person FCR in a pandemic scenario, yielding high levels of stakeholder satisfaction and support. We believe vFCR are a useful method to support inpatient rounds, physical distancing, and preservation of PPE that may also be valuable beyond the pandemic. A rigorous process evaluation of vFCR is underway.
Subject(s)
COVID-19 , Inpatients , Humans , Child , Pandemics , Quality Improvement , EmotionsABSTRACT
Purpose of Study: All-terrain vehicles (ATVs) are a significant cause of morbidity and mortality in children. Annually, over 100 pediatric ATV-related fatalities and >30 000 emergency department (ED) visits occur in the US. The Consumer Product Safety Commission (CPSC) cited a significant decrease (38%) in ATV-related ED visits from 2009-2018. Our study objectives were to: evaluate changes in the number of ATV injury visits in a pre-covid vs covid time frame, provide a descriptive epidemiology of our ATV injury visits, understand the impact of median household income and population type on amount ATV injuries, and realize preventative strategies for education intervention. Methods Used: A retrospective review of children <= 16 years old (yo) presenting to our pediatric hospital ED who were coded for ATV injury during 2019-2020 was conducted. An ATV patient database was developed and managed using Excel. This study was approved by our institutional IRB. Student t test and z test for proportions were utilized for statistical comparisons. National Center for Health Statistics was used to compare county population types. Summary of Results: There were 405 pediatric ED visits for ATV injuries January 2019 - December 2020. Overall, 77% were white. Ages ranged from 1 to 16 yo with an average age 10 yo (S.D. = 3.9). In 1-4 yos, 66% were passengers, 30% drivers. After 5 yo, >50% were drivers. Most common insurances were Alabama Blue Cross (45%), Medicaid (40%). A significant increase in ATV injuries occurred between 2019 and 2020. By comparing seasons, we found increase in spring (30%), fall (72%), and winter (52%) 2020 compared to 2019. Orthopedic injuries were the most common (60%) while 12% of injuries were brain and/or spinal cord injuries. We found 40% and 60% female vs male with no significant difference in gender distribution by disposition, and no significant difference in ages for admitted vs discharged (t = 0.93, p = 0.3). The range of length of stay for the discharged was 1-9 hours (average 3.5 hours) and admitted was 0-70 days (average 5.2 days). We found a bimodal distribution among the counties. With median household income, the peaks were $30 000-39 000 with 5.7 ATV injuries per 10 000 children and $70 000-79 999 with 6.3 injuries per 10 000 children. With population types, the peaks were "large fringe metropolitan" with 9.4 injuries per 10 000 children and "noncore" with 4.2 injuries per 10 000 children. [Figure presented] Conclusion(s): Most ATV injuries occurred in whites with 62% male, 39% female. Orthopedic injuries were most common. There was a bimodal distribution of injuries among the patients' counties when evaluated by median income and population. Year 2020 had 2.2 times the rate of ED visits compared to 2019 (5.2 ATV injury visits per 1000 ED visits in 2020 and 2.4 ATV injury visit per 1000 ED visits (z = 8.1, p < 0.0001)). When comparing seasons, we found the greatest difference was fall 2020 (72% increase) vs 2019. The steady increase is the inverse of the national trend found by the CSPS. Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
We present a nucleic acid-based point-of-care diagnostic for the detection of the SARS-CoV-2 from saliva using an additively manufactured microfluidic cartridge. The assay uses reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) to detect the presence of SARS-CoV-2 RNA on-cartridge in a point-of-care optical detection system based on a smartphone. We show positive results within the 10-30 minutes range and integrated biological controls on the cartridge. We demonstrate the microfluidic diagnostic with human patient samples, with results that are consistent with the off-cartridge validation. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.
ABSTRACT
Health care systems and providers have rapidly adapted to virtual care delivery during this unprecedented time. Clinical programs initiated a variety of virtual care delivery models to maintain access to care, preserve personal protective equipment, and minimize infectious disease spread. Herein, we first describe the context within paediatric health delivery during the COVID-19 pandemic in Canada that fueled the rise of virtual care delivery. We then summarize the development, implementation, and beneficial impact of the innovative virtual care delivery programs currently in use at Children's Hospital of Eastern Ontario (CHEO) for both inpatient and outpatient care, specifically in our ambulatory clinics, emergency department, and mental health program. We highlight the transferable unique ways CHEO has integrated virtual care delivery through our governance structure, stakeholder engagement including patient, caregivers and health care providers and staff, development, and use of eHealth tools and novel approaches for patient care requiring physical assessment. We conclude with our vision for the future of virtual care, one component of paediatric care delivery in the post-COVID-19 era, which requires a common framework for virtual care evaluation. Importantly, rapid implementation of a primarily virtual care model at CHEO sustained high volume quality paediatric care. We believe many of these programs should and will remain in the post-pandemic era. A comprehensive, unified approach to evaluation is essential to yield meaningful results that inform sustainable care delivery models that integrate virtual care, and ultimately help ensure the best health outcomes for our patients.
ABSTRACT
Purpose of Study Dog bites have historically been a common cause of pediatric emergency department (ED) visits. In June 2020 in the Journal of Pediatrics, 'Dog Bites in Children Surge during Coronavirus Disease-2019: A Case for Enhanced Protection' discussed an almost three-fold increase in dog bites treated in the ED since the beginning of the COVID-19 pandemic at an urban Children's Hospital in the Midwest. This study aimed to describe the epidemiology of dog bite ED visits and to evaluate changes in dog bite visits over 2019 (pre-COVID) and 2020 (during COVID). This study addressed two objectives: 1) To describe the epidemiology of dog bite related ED visits and admissions;2) To evaluate changes in the rate of dog bite ED visits during pre- Covid and during Covid. Methods Used This study reviewed 2 years (2019 and 2020) of dog bite visit data from the 'Children's Injury Database' (CID), our injury surveillance system of ED attended injuries. Descriptive statistical and epidemiologic analyses were conducted using Epi Info 7 (CDC). Statistical comparisons and analyses of continuous and categorical data were performed. Differences in proportions and T Test of means were reported with corresponding 95% Confidence Intervals (CI's). Summary of Results During the 2 year period, 522 dog bite cases were treated representing 1.7% of all injury visits. Gender analyses indicated a higher proportion of males vs females (53.6% vs 46.4%), respectively, overlap of exact CI's of proportions were observed. A higher proportion of white patients vs nonwhites among dog bite cases was observed (62.8% vs 37.2%), respectively, (no overlap of exact confidence intervals of proportions). This difference was also significant when comparing race proportions of dog bite visits to all other injury visits (62.8% vs 48.7%), respectively, difference of 14.1%, 95% CI (9.8, 18.2). Mean patient age was 6.1 yrs. Outcome metrics included patient disposition (3 categories): Admitted 57 (10.9%), Discharged 458 (87.7%), Other 7 (1.4%). Admitted patients were younger (statistically) 4.9 yrs vs 6.3 yrs, age difference -1.4 yrs 95% CI diff (-0.3, -2.5). Total length of stay for Admitted = 117 days (mean 2.1 days) and for Discharged mean hrs in the ED 3.7 (s.d. 8.7). Total charges were $2.6 million (mean = $4902, median $2043). The leading anatomic sites injured were head, face, and neck, all ages, (61.1%), but accounted for 79.8% for ages under 6 yrs. An increase in the rate of dog bite visits was detected during 2020 vs 2019, (20.4 per 1,000 injury visits vs 14.6 per 1,000 visits, rate difference = 5.8, 95% CI (3.4, 9.6). Conclusions The pandemic of COVID-19 with a national shel- #538 Figure 1 Overall CMV testing among failed hearing ter in place order was associated with more dog bite visits in the ED. 2020 had 20% fewer total injury visits than 2019, yet 10.5% higher number of dog bite visits. Dog bites are a significant cause of injury in children and result in costly visits seen in the ED. These data will support parental education on preventing dog bite injuries in children.