A National US Survey of Pediatric Emergency Department Coronavirus Pandemic Preparedness

Abstract

Objective We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. Methods We conducted a prospective multicenter survey of PED medical director(s) from selected children’s hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through an established national research network. Results We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non–COVID-19 patients, 60% had COVID-19–dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). Conclusions This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.

The Effect of COVID-19 on United States Pediatric Emergency Departments and Its Impact on Trainees

“…The timing and magnitude of PED volume drop in our study is consistent with previously published studies from the US and around the world during the pandemic. 9,10,11 In many cases, the census decline occurred despite increased PED patient age cut-offs. On the other hand, the percentage of PED admissions increased during the same period.…”

Challenges Created by the COVID-19 Pandemic: Pediatric Emergency Medicine and Disaster Management Perspectives

“…In a national survey of 25 PEDs, mass email messaging was utilized by 96% of the institutions during the COVID-19 pandemic. 20 Email is a quick and easy communication modality that can be utilized to update departments and reiterate important information that is rapidly evolving. 21,22 However, as our participants discussed and as mentioned in previous studies, the number of emails received per day can be overwhelming.…”

“…18 Following the 2009 H1N1 outbreak, the Institute of Medicine developed the crisis standards of care, emphasizing the importance of early preparation and management of resources during a disaster to maximize patient care and minimize harm. 20,28 This framework for disaster preparedness was discussed by several of the participants and was evident in discussions around ACSs, re-deploying staff to care for 8 TE Tanner et al…”

Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory

“…The buddy oversight enabled better following of the respective protocols and checklists, and mutual control of the equipment for completeness and intactness in mitigatating risks and errors. This helped to boost confidence in the PPE during the COVID pandemic, which has exposed a serious HCW trust gap in management around the world (Auerbach et al, 2021). Mirrors in the locker room and the adjacent airlock room facilitated the correct donning of multilayer PPE variants, as recommended by Ruskin et al (2021).…”

“…However, no health care system expected the magnitude of personnel and PPE requirements and high consumption, nor the workload needed to contain SARS-CoV-2. As a consequence emergency training on PPE use had to be initiated rapidly according to the CDC guidelines (CDC, 2020(CDC, , 2021Auerbach et al, 2021). However, this required experienced trainers who were often not available.…”