Up to the Challenge: Adapting Pediatric Intensive Care During a Global Pandemic

Abstract

BackgroundThe COVID-19 pandemic has strained health systems world wide. In our region, surging numbers of critically ill adult patients demanded urgent system-wide responses. During the peak of the pandemic, our Pediatric Intensive Care Unit (PICU) team redesigned the existing educational resources and processes of care to ensure for adult patients for the first time in the hospital’s history.AimDescribe the experiences and impacts of the rapidly initiated Adult COVID-19 Program on health care providers (HCP) and family members. Havelock’s Theory of Change framed the examination of Adult COVID-19 Program participant experiences and surfaced lessons learned.Materials and MethodsA quality improvement review was employed to collect feedback about the program experience from the health care team and patient’s family members. HCP completed a questionnaire 10 months following the implementation of the program and feedback from family members was provided during the program was obtained. Havelock’s Theory of Change was used to explore trends and frame participants’ experiences.ResultsPediatric Intensive Care Unit bedside team members and clinical leaders (n = 17), adult hospital partners (n = 3), and family members (n = 8) participated. HCP describe; motivation and readiness; concern for personal safety and uncertainty experienced in the early program phases; the importance of supports and resources; use of relationships and collaboration to facilitate change; the emotional impacts of this unique experience; and opportunities for individual and team growth. An overarching theme of ‘doing our part to help’ emerged. Family members described the positive impacts of family-centered interventions offered, individualized care, and shock at their family member’s illness.ConclusionThe PICU team rapidly adapted to provide care for adults at the peak of the pandemic. Family members expressed feeling grateful for the care their loved ones received in the pediatric setting. The experience of caring for adult patients with COVID-19 was a source of tension, personal growth, and meaning for the pediatric intensive care team.

Pediatric capacity crisis: A framework and strategies to prepare for a pediatric surge

“… 51 , 58 Similar concerns would likely arise for adult‐focused clinicians caring for children. However, alongside the stresses of caring for adults during the COVID‐19 surge, pediatric clinicians found meaning in caring for patients during a global pandemic and expressed pride in discovering they were “more flexible and adaptable than [they] would have thought possible.” 53 …”

“… 10 , 51 To care for pediatric patients, adult‐trained clinicians need to learn weight‐based medication administration; age‐based vital sign ranges; management of common pediatric illnesses (eg, bronchiolitis, croup); and legal and ethical considerations around consent, assent, and mandatory reporting for children. 35 Pediatricians also practice family‐centered, developmentally appropriate care 52 , 53 and often have more permissive visitor policies than those for adult patients. 10 Additionally, clinicians should receive specific training on how pediatric advanced life support differs from advanced cardiovascular life support for adults, in the event they are caring for a patient who clinically deteriorates.…”