ABSTRACT
BACKGROUND: The coronavirus pandemic continues to shake the embedded structures of traditional in-person education across all learning levels and across the globe. In healthcare simulation, the pandemic tested the innovative and technological capabilities of simulation programs, educators, operations staff, and administration. This study aimed to answer the question: What is the state of distance simulation practice in 2021? METHODS: This was an IRB-approved, 34-item open survey for any profession involved in healthcare simulation disseminated widely and internationally in seven languages from January 14, 2021, to March 3, 2021. Development followed a multistep process of expert design, testing, piloting, translation, and recruitment. The survey asked questions to understand: Who was using distance simulation? What driving factors motivated programs to initiate distance sim? For what purposes was distance sim being used? What specific types or modalities of distance simulation were occurring? How was it being used (i.e., modalities, blending of technology and resources and location)? How did the early part of the pandemic differ from the latter half of 2020 and early 2021? What information would best support future distance simulation education? Data were cleaned, compiled, and analyzed for dichotomized responses, reporting frequencies, proportions, as well as a comparison of response proportions. RESULTS: From 32 countries, 618 respondents were included in the analysis. The findings included insights into the prevalence of distance simulation before, during, and after the pandemic; drivers for using distance simulation; methods and modalities of distance simulation; and staff training. The majority of respondents (70%) reported that their simulation center was conducting distance simulation. Significantly more respondents indicated long-term plans for maintaining a hybrid format (82%), relative to going back to in-person simulation (11%, p < 0.001). CONCLUSION: This study gives a perspective into the rapid adaptation of the healthcare simulation community towards distance teaching and learning in reaction to a radical and quick change in education conditions and environment caused by COVID-19, as well as future directions to pursue understanding and support of distance simulation.
ABSTRACT
Objective: To determine the immediate impacts of the COVID-19 Shelter-in-Place mandates (SIPM) on utilization of emergency room and inpatient care for patients with neurological diagnoses at pediatric hospitals. Background: The Coronavirus 2019 (COVID-19) pandemic lead to SIPM across the US to decrease transmission and alleviate pressure on healthcare systems, including recommendations to avoid elective hospitalizations. We hypothesized SIPM resulted in decreased hospital encounters for pediatric neurological diagnoses. Design/Methods: This retrospective cross-sectional study included all emergency, urgent-care and inpatient encounters with a neurological primary admission or discharge ICD-10 diagnosis code during the six-weeks post SIPM or same six-week timeframe from the prior three years from five US pediatric institutions. Patient demographics, length of encounter, utilization of neuroimaging, and EEG were extracted from the medical record. Results: Over four years and With in the six-week timeframes there were 20,504 included encounters. During SIPM there was a 51% (p<0.001) reduction in neurological hospital-based encounters. Patients were younger (median 7yrs vs. 5.1yrs, p<0.001), and encounters for African Americans decreased (OR 0.88 CI 0.79-0.98, p=0.02) compared to prior years. During SIPM length of stay increased by one day (median 2 vs. 3 days, p<0.01), and relative utilization of intensive care increased by 66% (p<0.01). Migraine encounters had a relative decrease during SIPM by 47% (12.8%-8.0%, p<0.001). Emergent diagnoses had relative increases, with admissions for TBI increasing 60% (13.5%-21.6%, p<0.001) and status epilepticus 38% (9.1%- 12.62%, p=0.003). Diagnostic testing proportionally increased including: continuous EEG (20%, p<0.01), brain MRI (55%, p<0.001), and head CT (60%, p<0.001). Conclusions: COVID-19 SIPM led to overall decreased utilization of hospital-based care for neurological diagnosis and a relative increase in neurological emergencies, utilization of intensive care, EEG, and neuroimaging. These data support preserved staffing of hospital-based neurological services during SIPM. Further studies are needed to determine the impact of increased imaging, racial disparities, and potentially delayed diagnosis or treatment.