The doctor will see you now-optimising inpatient and outpatient paediatric care during the COVID-19 pandemic in a UK district general hospital

ABSTRACT

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.