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Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617072


Introduction: The first wave of the COVID-19 pandemic required paediatric departments to quickly adapt to changing infection control policies, including altering physical space, pathway and rota restructuring, and adopting telemedicine platforms. As it emerged that COVID-19, as a disease entity, does not severely affect children, it became apparent the biggest challenges in delivering excellent care would be to overcome operational and organisational obstacles. Other challenges included delayed presentations of other conditions, waning staff morale and lack of paediatric specific infection control data and guidance. Methods: Our district general hospital's paediatric department established working groups comprising senior paediatricians, infection control leads and nursing managers. They regularly met during the first wave with the aim to optimise inpatient and outpatient paediatric care, agree on paediatric specific pathway changes and ensure staff morale was maintained. Actions: Paediatric doctors took over management of the paediatric emergency department (ED) to support adult services. Consultants became residents overnight to help manage ED and the requirements of a 'red' and 'yellow' admission pathway. We implemented a thrice-weekly multi-disciplinary resuscitation simulation to ensure all staff were aware of COVID adaptions to paediatric resuscitation algorithms. Weekly staff debriefs held to ensure the dissemination of pathway updates and to prioritise staff morale. Emergency funding led to the acquisition of new equipment to avoid cross-contamination with adult areas (e.g. blood gas analysers). Outpatient referrals were double-vetted by consultants and seen promptly. Over one year from January 2020, 8,104 children were seen in the clinic;4,619 (57%) were new referrals and seen face-to-face. We worked with adult services;the paediatric outpatient area was converted to an overflow adult ED. Paediatrics utilised an adult area with a larger footprint to continue face-to-face outpatient appointments. We extended our community nursing service to 7 days a week (from 5) to ensure more streamlined ambulatory care. Conclusions: Adaptability and flexibility were fundamental in implementing paediatric specific pathways. Schedule supportive team debriefs to promote staff wellbeing. Work with adult services to maintain excellent patient care throughout both specialities-we took over paediatric ED and utilised adult space to continue outpatient clinics. Anecdotally paediatricians preferred, and felt safer, undertaking face-to-face consultations for new outpatient appointments. Most children were not seen by their general practitioner prior to referral. We advocate ensuring all new outpatient referrals are seen face-to-face. Telemedicine was the preferred method for reviewing outpatient follow-ups. More research is required into the opportunities and barriers of paediatric telemedicine.

Archives of Disease in Childhood ; 106(SUPPL 1):A194, 2021.
Article in English | EMBASE | ID: covidwho-1495063


Background The COVID-19 pandemic required doctors to quickly adapt to new infection-control policies, rota restructuring and pathway changes. There was uncertainty on how the pandemic would affect paediatrics, as well as anxiety of the personal COVID-19 effects, frustration with media reporting and potential isolation with social-distancing measures. Our department recognised that both junior and senior doctors needed a platform to come together to address these feelings and reflect on them, ensuring a supportive team at work during this challenging period. Objectives To implement a supportive debrief session within the paediatric unit's teaching programme to improve team morale and reduce anxiety on the uncertainties of the pandemic. Methods During the first wave of the pandemic (April 2020- August 2020) we ran a weekly 'debrief hour' scheduled within the departmental teaching programme. Co-led by the college tutor, clinical director and trainee representatives, it was open to paediatric junior doctors and consultants. These sessions were held face-to-face and virtually. During the second wave (October 2020-February 2021) these sessions were held fortnightly and were focused on wellbeing. One week prior to each session questionnaires were completed anonymously by junior doctors to collate issues they wished to reflect on. Postdebrief surveys were completed by participants. Results We ran a total of 30 sessions. During the first wave 18 junior doctors and 5 consultants on average attended each debrief. Topics of discussion varied from difficult clinical cases and the emotional challenges of the pandemic to learning about individual approaches to mindfulness. Anecdotally junior doctors appreciated this dedicated time to 'offload' in a safe space. It helped forge bonds and personal connections within the team. Overall doctors were grateful their wellbeing was prioritised by these sessions. We took this initiative forward into the second wave where sessions became fortnightly. Our post-debrief surveys revealed that 96% (N=19) of junior doctors valued this time for team reflection and connection. 92% (N=19) found them useful. 94% (N=19) would like to see these sessions continue after the pandemic. Feedback included junior doctors 'feeling supported', 'paediatrics being the best team' and 'bonding during a worrying time'. From March 2021 these sessions will be led by the department's clinical psychologist. Conclusions • We advocate scheduling a supportive debrief session within departmental teaching programmes, especially in times of uncertainty and potential anxiety (such as global pandemics). This encourages team bonding. • Embedding debrief sessions within the teaching programme sends a clear message to junior doctors that the department prioritises and promotes the wellbeing of doctors, seeing it as an important part of their working lives. • Supportive debrief sessions allow doctors a safe space to 'offload' with their peers in a reflective, relaxed environment, thus helping create a sense of community at work and improving morale. • The department will continue to hold scheduled team debriefs, which will carry on after the pandemic. The Trust recognises the importance of championing wellbeing;moving forward time has been allocated for a clinical psychologist to lead these sessions. • We strongly recommend that budget planning includes provision for trainee wellbeing support services.