The <scp>COVID</scp>‐19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in <scp>resource‐limited</scp> hospitals

Wiphatphumiprates, Parima P; Graetz, Dylan E.; Ferrara, Gia; Puerto-Torres, Maria; Gillipelli, Srinithya R.; Elish, Paul; Muniz-Talavera, Hilmarie; Gonzalez-Ruiz, Alejandra; Armenta, Miriam; Barra, Camila; Carpio, Zulma; Hernandez, Cinthia; Juarez, Susana; Loeza, José de Jesús; Mendez, A Ruiz; Montalvo, Erika; Penafiel, Eulalia; Pineda, Estuardo; McKay, Virginia; Agulnik, Asya

doi:10.1002/cam4.5876

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…The COVID-19 pandemic has posed an unprecedented global threat to the safe, effective, and timely care of children with cancer ( 20 - 22 ). Along with the physical, psychological, and financial impact of the pandemic, pediatric oncologists around the world face numerous challenges, including staffing shortages and occupational safety issues ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the demographic and disease burden of pediatric malignant solid tumors in China: a single-center, cross-sectional study

Jiang,

Yang,

Yang

et al. 2024

Transl Pediatr

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Background With the development of the novel coronavirus disease 2019 (COVID-19), China implemented measures in an attempt to control the infection rate. We conducted a single-center, cross-sectional study to ascertain the impact of the COVID-19 pandemic on the equitable availability of medical resources for children diagnosed with malignant solid tumors in China. Methods Data on the demographics, clinical characteristics, and medical expenses of 876 patients diagnosed with neuroblastoma, rhabdomyosarcoma (RMS), Wilms tumor, hepatoblastoma (HB), Ewing sarcoma (ES), and central nervous system (CNS) tumors from 2019 to 2021, during the COVID-19 pandemic, were retrospectively collected from the National Center for Children’s Health. The Pearson χ 2 test and Mann-Whitney test were performed to analyze the differences among variables. Results Except for the regional origin of children with tumors during the epidemic, no significant differences were found in the demographic or clinical characteristics of patients at initial diagnosis. The number of patients from northern China and northeastern China who attended Beijing Children’s Hospital (BCH) increased after the outbreak of COVID-19 (P=0.001). There was no significant alteration observed in the frequency of hospitalizations per individual per annum (P=0.641) or the mean expense incurred per individual per hospitalization (P=0.361). In addition, the medical insurance coverage rate of real-time settlement increased year by year. Conclusions After the COVID-19 outbreak, the origin of patients with solid tumor who visited BCH was concentrated in the northern region of China. COVID-19 had no impact on the other demographic factors, clinical characteristics, or economic burden of patients with pediatric malignant solid tumors.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the demographic and disease burden of pediatric malignant solid tumors in China: a single-center, cross-sectional study

Jiang,

Yang,

Yang

et al. 2024

Transl Pediatr

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The COVID‐19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource‐limited hospitals

et al. 2023

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Background The COVID‐19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource‐limited settings. This study evaluates its impact on existing quality improvement (QI) programs. Methods We conducted 71 semi‐structured interviews of key stakeholders at five resource‐limited pediatric oncology centers participating in a collaborative to implement Pediatric Early Warning System (PEWS). Interviews were conducted virtually using a structured interview guide, recorded, transcribed, and translated into English. Two coders developed a codebook of a priori and inductive codes and independently coded all transcripts, achieving a kappa of 0.8–0.9. Thematic analysis explored the impact of the pandemic on PEWS. Results All hospitals reported limitations in material resources, reduction in staffing, and impacts on patient care due to the pandemic. However, the impact on PEWS varied across centers. Identified factors that promoted or limited ongoing PEWS use included the availability of material resources needed for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to prioritize PEWS. Consequently, some hospitals were able to sustain PEWS; others halted or reduced PEWS use to prioritize other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units. Several participants were hopeful for future expansion of PEWS post‐pandemic. Conclusion The COVID‐19 pandemic created challenges for sustainability and scale of PEWS, an ongoing QI program, in these resource‐limited pediatric oncology centers. Several factors mitigated these challenges and promoted ongoing PEWS use. These results can guide strategies to sustain effective QI interventions during future health crises.

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Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource‐limited pediatric oncology centers

et al. 2023

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BackgroundPediatric Early Warning Systems (PEWS) assist early detection of clinical deterioration in hospitalized children with cancer. Relevant to successful PEWS implementation, the “stages of change” model characterizes stakeholder support for PEWS based on willingness and effort to adopt the new practice.MethodsAt five resource‐limited pediatric oncology centers in Latin America, semi‐structured interviews were conducted with 71 hospital staff involved in PEWS implementation. Purposive sampling was used to select centers requiring variable time to complete PEWS implementation, with low‐barrier centers (3–4 months) and high‐barrier centers (10–11 months). Interviews were conducted in Spanish, professionally transcribed, and translated into English. Thematic content analysis explored “stage of change” with constant comparative analysis across stakeholder types and study sites.ResultsParticipants identified six interventions (training, incentives, participation, evidence, persuasion, and modeling) and two policies (environmental planning and mandates) as effective strategies used by implementation leaders to promote stakeholder progression through stages of change. Key approaches involved presentation of evidence demonstrating PEWS effectiveness, persuasion and incentives addressing specific stakeholder interests, enthusiastic individuals serving as models for others, and policies enforced by hospital directors facilitating habitual PEWS use. Effective engagement targeted hospital directors during early implementation phases to provide programmatic legitimacy for clinical staff.ConclusionThis study identifies strategies to promote adoption and maintained use of PEWS, highlighting the importance of tailoring implementation strategies to the motivations of each stakeholder type. These findings can guide efforts to implement PEWS and other evidence‐based practices that improve childhood cancer outcomes in resource‐limited hospitals.

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The COVID‐19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource‐limited hospitals

Cited by 4 publications

References 32 publications

Impact of the COVID-19 pandemic on the demographic and disease burden of pediatric malignant solid tumors in China: a single-center, cross-sectional study

Impact of the COVID-19 pandemic on the demographic and disease burden of pediatric malignant solid tumors in China: a single-center, cross-sectional study

The COVID‐19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource‐limited hospitals

Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource‐limited pediatric oncology centers

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