The Secondary Consequences of the COVID-19 Pandemic in Hospital Pediatrics

Diskin, Catherine; Orkin, Julia; Agarwal, Tanvi; Parmar, Arpita; Friedman, Jeremy

doi:10.1542/hpeds.2020-002477

Cited by 18 publications

(21 citation statements)

References 13 publications

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“… 2 Parents also reported isolation as a big problem when at health care facilities due to the limitation in number of family members per patient permitted. 5 As a result of these challenges, parents describe substantial feelings of distress. On a positive note, many parents have adapted to virtual modalities of care during the pandemic which are preferred in certain instances, even when some limitations are recognized.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 4 Adverse outcomes observed in otherwise healthy children following the social isolation recommended by the CDC guidelines include delay in access to care, decreased physical activity, increased emotional distress, and increased domestic violence in the home. 5 , 6 , 7 , 8 , 9 , 10 While current literature describes substantial effects of COVID-19 on children's daily life and parental health, 10 , 11 , 12 , 13 , 14 , 15 , 16 few studies have assessed the impact of COVID-19 on caring for children with serious illnesses.…”

Section: Introductionmentioning

confidence: 99%

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Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children

Beight

Helton

Avery

et al. 2022

Journal of Pain and Symptom Management

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Context : Few studies have explored the impact of the Coronavirus Pandemic (COVID-19) on the care of seriously ill children which may be especially affected due to the child's vulnerability, complexity of care, and high reliance on hospital-based care. Objective : To explore parental and adolescent perspectives on the impact of COVID-19 on care of seriously children. Methods : We recruited a convenience sample of families of seriously ill children between September and December 2020. The study involved a semi-structured interview through Zoom followed by an online sociodemographic survey. Interviews were transcribed and coded using the constant comparison method. The sample intended to represent diversity in child age and diagnoses, and family sociodemographic characteristics. Results : Sixty-four families were approached; 29 enrolled (response rate 45%), including 30 parents and three AYAs. Most parents and AYAs identified as white (62%). Some families reported new financial hardships, with 17.2% having difficulty paying bills after March 2020 compared to 6.9% before. Emerging themes from interviews included additional roles parents managed due to cancelled services or shifting to telehealth, increased isolation, high emotional distress due increased in-home demands, uncertainty, and visitor restrictions in medical facilities, and benefits and challenges to telehealth . One positive outcome was the use of a hybrid care model whereby families choose telehealth appointments and in-person services, when necessary. Conclusion : Families caring for seriously ill children during COVID-19 face increased challenges. Health systems should consider long-term telehealth/in-person hybrid care models that have potential to improve access to and satisfaction with care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children

Beight

Helton

Avery

et al. 2022

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

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“…Our findings largely align with previous research. In a single-center qualitative study, Diskin et al 16 describe similar impacts of the pandemic on the quality of inpatient pediatric care in a free-standing children's hospital. They describe how visitor policies and changes in communication decreased patient and family engagement and discuss the limitations of telehealth.…”

Section: Discussionmentioning

confidence: 99%

“…They suggest potential adverse quality outcomes due to decreases in patient/family-centeredness and timeliness of care. 16 However, these previous studies mainly focus on free-standing children's hospitals, where <30% of children are hospitalized nationally. 17 In addition, to our knowledge, there have been no multicenter studies exploring the mechanisms by which challenges during the pandemic may have impacted inpatient pediatric quality and safety.…”

mentioning

confidence: 99%

Quality and Safety in Hospital Pediatrics During COVID-19: A National Qualitative Study

Angulo

Penwill

Pathak

et al. 2021

Hospital Pediatrics

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OBJECTIVE: To describe challenges in inpatient pediatric quality and safety during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In a previous qualitative study, our team sought to broadly describe changes in pediatric inpatient care during the pandemic. For both that study and this ancillary analysis, we purposefully sampled participants from community and children’s hospitals in the 6 US states with the highest COVID-19 hospitalization rates from March to May 2020. We recruited 2 to 3 participants from each hospital (administrators, front-line physicians, nurses, caregivers) for semistructured interviews. We used constant comparative methods to identify themes regarding quality and safety challenges during the pandemic. RESULTS: We interviewed 30 participants from 12 hospitals. Participants described several impacts to clinical workflows, including decreased direct clinician-patient interactions and challenges to communication, partly addressed through innovative use of telehealth technology. Participants reported changes in the discharge and transfer process (eg, discharges, difficulties accessing specialized facilities). Participants also described impacts to hospital operations, including changes in quality monitoring and operations (eg, decreased staff, data collection), increased health risks for clinicians and staff (eg, COVID-19 exposure, testing delays), and staff and supply shortages. Participants voiced concerns that negative quality and safety impacts could include increased risk of preventable safety events and hospital readmissions, and decreased patient engagement, education, and satisfaction. CONCLUSIONS: We identified several impacts to clinical workflows and hospital operations during the pandemic that may have affected inpatient pediatric care quality and safety. Our findings highlight potentially important areas of focus for planning pandemic recovery, preparing for future pandemics, and conducting future research on inpatient pediatric quality and safety.

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“…A brief interim report, completed mid-way through the study, was previously published. 15 We disseminated early results in real-time to inform healthcare leaders and decision-makers about the breadth of the impact associated with the COVID-19 pandemic.…”

Section: Methodsmentioning

confidence: 99%

Disruptions in Care: Consequences of the COVID-19 Pandemic in a Children’s Hospital

Diskin

Orkin

Dharmaraj

et al. 2021

Preprint

Self Cite

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BackgroundPublic health restrictions are an essential strategy to prevent the spread of COVID-19; however, unintended consequences of these interventions may have led to significant delays, deferrals and disruptions in medical care. This study explores clinical cases where the care of children was perceived to have been negatively impacted as a result of public health measures and changes in healthcare delivery and access due to the COVID-19 pandemic.MethodsThis study used a qualitative multiple case study design with descriptive thematic analysis of clinician-reported consequences of the COVID-19 pandemic on care provided at a children’s hospital. A quantitative analysis of overall hospital activity data during the study period was performed.ResultsThe COVID-19 pandemic has resulted in significant change to hospital activity at our tertiary care hospital, including an initial reduction in Emergency Department attendance by 38% and an increase in ambulatory virtual care from 4% before COVID-19, to 67% in August, 2020. Two hundred and twelve clinicians reported a total of 116 unique cases. Themes including (1) timeliness of care, (2) disruption of patient-centered care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic emerged, each impacting patients, their families and healthcare providers.ConclusionBeing aware of the breadth of the impact of the COVID-19 pandemic across all of the identified themes is important to enable the delivery of timely, safe, high-quality, family-centred pediatric care moving forward.What’s newCOVID-19 disrupted typical paediatric care delivery.This study demonstrates the breadth of its’ impact on the delivery of timely, safe, equitable and patient and family centered care, highlighting considerations for paediatric providers as we move forward.

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The Secondary Consequences of the COVID-19 Pandemic in Hospital Pediatrics

Cited by 18 publications

References 13 publications

Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children

Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children

Quality and Safety in Hospital Pediatrics During COVID-19: A National Qualitative Study

Disruptions in Care: Consequences of the COVID-19 Pandemic in a Children’s Hospital

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