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

Tanner, Thomas E.; Davis, Nichole R; Kaziny, Brent D.; Endom, Erin E; Sampayo, Esther M.

doi:10.1017/dmp.2022.153

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…The coronavirus disease 2019 (COVID-19) pandemic also introduced additional barriers to accessing healthcare services, particularly for non-critical or indirect clinical activities, such as preparatory activities. Furthermore, as process and practice standards evolved during the pandemic responses, the efficiency was reduced due to added infection control requirements and the additional accommodations put in place to ensure individual comfort levels of both staff and patients [10]. Virtual reality (VR) is one tool that can be used to help educate patients and their families about medical imaging and simulate the experience of being scanned without coming to the hospital for onsite preparation [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis

Jacob

Stunden

Deenadayalan

et al. 2023

PharmacoEconomics Open

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Introduction Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)—virtual reality (VR-MRI) and a certified Child Life Program (CLP). Methods A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs. Results VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged from CAN$190.69 to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91–$426.64) to CAN$3843.41 (CAN$3196.59–$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20–$188.76) to CAN$283.85 (CAN$283.71–$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient. Conclusions While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes o...

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Section: Introductionmentioning

confidence: 99%

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis

Jacob

Stunden

Deenadayalan

et al. 2023

PharmacoEconomics Open

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“…Establishing recommendations at the national level might also ensure harmonization [ 29 ]: the pandemic has affected each country differently, with those nursing programs located in the most affected regions having been forced to revolutionize the curriculum, thus acquiring in-depth insights into the changes needed in the future, while to a different degree/extent there are those that have been required to enact fewer changes, thus preventing an understanding of how to design the nursing education in the post-pandemic era. Moreover, a part of embodying the lesson learned, redesigning nursing education based on agreed recommendations, may promote common standards of education, and create the basis on how to deal with future pandemic/catastrophic events by making the educational systems ready and prepared [ 30 , 31 ]. Therefore, the aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era.…”

Section: Introductionmentioning

confidence: 99%

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study

et al. 2023

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Background During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. Methods A qualitative descriptive design was undertaken in 2022–2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor’s degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. Results Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. Conclusions A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

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“…11 More recent trends, including significantly increasing volumes of pediatric patients with behavioral health complaints, large fluctuations in patient volumes, the SARS-CoV-19 pandemic, and new transmission patterns of infectious diseases, have stressed pediatric EDs. [12][13][14][15][16][17] While patient volumes and mix do not change abruptly, they eventually reach a threshold that prompts pediatric EDs to innovate clinical operations models in response. These include increasing primary care utilization, transferring care for boarding patients to inpatient teams, increasing the care provided in triage, and creating alternative care sites for seeing patients.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies have shown variability and gaps in exposure to core pediatric diagnoses during pediatric ED rotations 11 . More recent trends, including significantly increasing volumes of pediatric patients with behavioral health complaints, large fluctuations in patient volumes, the SARS‐CoV‐19 pandemic, and new transmission patterns of infectious diseases, have stressed pediatric EDs 12–17 . While patient volumes and mix do not change abruptly, they eventually reach a threshold that prompts pediatric EDs to innovate clinical operations models in response.…”

Section: Introductionmentioning

confidence: 99%

Alternative care sites and resident exposure in pediatric emergency medicine: Who, what, and where

Miller,

Cavallaro,

Hirsch

et al. 2023

AEM Education and Training

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ObjectivesEmergency medicine (EM) physicians and pediatricians who provide acute pediatric care depend on clinical exposure during residency to learn pediatric EM. Increasing volumes of pediatric patients, especially with behavioral health complaints, have stressed pediatric emergency departments (ED) and prompted clinical operations innovations including alternative care sites outside the main ED. We investigated the impact of these recent trends and resulting alternative care sites on the exposure of residents to core pediatric conditions.MethodsThis retrospective study reviewed patient encounters between July 1, 2018, and December 31, 2022, at a pediatric ED that hosts one pediatric and three EM residencies. During the study, the hospital employed alternative care sites in response to increased and shifting patient populations. Median patients per resident per academic year were compared before and after the opening of alternative care sites, overall and stratified by patient factors (age, sex, Emergency Severity Index [ESI], and diagnostic category). The study also compared the percentage of residents who saw no patients with a given diagnosis between the two periods.ResultsOf 231,101 patient encounters, 199,947 were seen in the main ED and 31,154 in alternative care sites. The median number of patients seen by a single resident in a single academic year ranged from 82 to 136 for pediatric residents and from 128 to 183 for EM residents. The median number of patients per resident per year did not decrease for any age group, sex, ESI level, or diagnosis across the two periods. Residents saw a median of 19 more patients with psychiatric diagnoses (95% CI 15.4–22.7) in the more recent period. Seven diagnoses were not seen by at least 20% of residents during both periods.ConclusionsCurrent pediatric ED capacity challenges can be addressed with alternative care sites without decreasing volume or variety of patients seen by residents.

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

Cited by 4 publications

References 35 publications

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study

Alternative care sites and resident exposure in pediatric emergency medicine: Who, what, and where

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