Moving from Vaccine Hesitancy to Acceptance: Engaging Underrepresented Employees in a Pediatric Academic Medical Center.

Underrepresented populations historically underserved by the healthcare system and/or marginalized by systematic policies regionally and nationally were particularly vulnerable during the COVID-19 pandemic. While vaccine hesitancy has been described among hospital employees, the employees' experiences from an underrepresented population cohort have not been reported. We, therefore, sought to understand employees' vaccine experiences, hesitancy, and ways to enhance ongoing COVID-19 vaccine education and communication to build a hospital-wide culture of vaccine acceptance. Methods: We invited interprofessional staff from 5 clinical departments to participate in qualitative focus groups. Guiding questions were used to explore the experiences and perceptions of the staff. Using content analysis, we identified themes and recommendations for improvement. Results: We conducted 5 focus group sessions with over 50 participants. Four themes emerged; "Vaccine Fears Past and Present," "Access to Information," "Worries for Families," and "Our Hospital is a Trusted Name." Participants also provided recommendations for improvement in the messaging around the vaccine rollout. Consideration of how different employees access information, listening to staff needs, and recognizing the role of race and history were critical to engaging and improving the underrepresented employees' vaccine acceptance. Conclusions: Exploring the concerns and fears of the COVID-19 vaccine within groups of underrepresented staff members through qualitative methods was key to understanding their vaccine hesitancy and implementing strategies to move toward vaccine acceptance in the hospital.

Effects of COVID-19 on paediatric cardiac centres in low-income and middle-income countries: a mixed-methods study.

OBJECTIVES: The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries. DESIGN: A mixed-methods approach was used. SETTING: Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for congenital heart disease (CHD) were identified. PARTICIPANTS: Eight IQIC sites in low-income and middle-income countries agreed to participate. OUTCOME MEASURES: Differences in volume and casemix before and during the pandemic were identified, and semistructured interviews were conducted with programme representatives and analysed by two individuals using NVivo software. The qualitative component of this study contributed to a better understanding of the centres' experiences and to identify themes that were common across centres. RESULTS: In aggregate, among the seven critical access sites that reported data in both 2019 and 2020, there was a 20% reduction in case volume, though the reduction varied among programmes. Qualitative analysis identified a universal impact for all programmes related to Access to Care/Clinical Services, Financial Stability and Professional/Personal Issues for healthcare providers. CONCLUSIONS: Our study identified and quantified a significant impact of the COVID-19 pandemic on critical access to CHD surgery in low-income and middle-income countries, as well as a significant adverse impact on both the skilled workforce needed to treat CHD and on the institutions in which care is delivered. These findings suggest that the COVID-19 pandemic has been a major threat to access to care for children with CHD in resource-constrained environments and that this effect may be long-lasting beyond the global emergency. Efforts are needed to preserve vulnerable CHD programmes even during unprecedented pandemic situations.

Expanding Hospital Capacity during the COVID-19 Pandemic: The Family Voice Matters.

During the initial COVID-19 response, this children's hospital reduced its inpatient capacity by 52 beds with double rooms' conversion to single patient occupancy, causing significant capacity constraints. To solve this challenge, the family perspective was engaged to safely redouble patient rooms and expand capacity as clinical activity increased during the COVID-19 response. METHODS: The team conducted qualitative descriptive interviews with parents of children undergoing congenital heart surgery admitted to the inpatient cardiac unit in a 404-bed free-standing children's hospital. A 2-week pilot study utilizing patient-specific inclusion criteria, newly developed patient room guidelines, universal masking, physical distancing, and inpatient room enhancements with parent COVID-19 testing was conducted. RESULTS: Interviews were conducted [pre (n = 7) and post (n = 6)] regarding patient room redoubling. Participants perceived utilization of double rooms as safe with increased protection, including universal masking, physical distancing, room enhancements, and increased bathroom cleaning. However, some families verbalized anxiety regarding visitation restriction to one parent at a time at the bedside. Additional concerns were voiced around the timing of communication about the need to be placed in a double room. In response, visitation increased to 2 parents at bedside and communication of utilization of double rooms was included in preoperative preparations postpilot. Inclusion criteria were expanded to patients of all ages and included full use of shared in-room bathrooms by parents and patients. CONCLUSIONS: Parents perceived patient room redoubling as safe and family centered. Findings from the pilot study were used to scale broad utilization and increase access to care across the institution.