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

2021 ◽  
Author(s):  
Catherine Diskin ◽  
Julia Orkin ◽  
Blossom Dharmaraj ◽  
Tanvi Agarwal ◽  
Arpita Parmar ◽  
...  
Keyword(s):  
Public Health ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Unintended Consequences ◽  
Pediatric Care ◽  
Care Hospital ◽  
Children's Hospital ◽  
Centered Care ◽  
Children’S Hospital ◽  
The Impact

AbstractBackgroundPublic 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.

scholarly journals 89 The Unintended Consequences and Impact of the COVID-19 Pandemic on Patients, Families and Clinicians in a Children’s Hospital

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e64-e65
Author(s):  
Catherine Diskin ◽  
Julia Orkin ◽  
Blossom Dharmaraj ◽  
Tanvi Agarwal ◽  
Arpita Parmar ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Case Series ◽  
Unintended Consequences ◽  
Pediatric Care ◽  
Full Time ◽  
Negative Consequences ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Primary Subject area Hospital Paediatrics Background The coronavirus (COVID-19) pandemic has broad implications for children and families. Healthcare experience and delivery has changed significantly, and changes will likely continue for some time. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity. Objectives This study aimed (1) to describe the broader spectrum of unintended negative consequences by describing the courses of care altered by the COVID-19 pandemic from the clinician's perspectives and (2) to identify thematic similarities to inform clinical practice change. Design/Methods All full-time doctors, dentists, and nurse practitioners working at a tertiary care children’s hospital in Canada were surveyed every two weeks throughout the initial phase of the COVID-19 pandemic. We asked them to identify and describe clinical cases in which they perceived a negative outcome associated with hospital or societal changes due to the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes. Results Two-hundred and twelve clinicians reported 116 cases. Several broad themes emerged, including (1) timeliness of care, (2) disruption of child and family-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic. Within each of these themes, subthemes emerged, highlighting its impact on (1) patients, (2) their families and (3) healthcare providers. Table 1 provides examples of cases within each theme. Conclusion The broad consequences of the COVID-19 pandemic impact patients, families, healthcare providers and the healthcare system. Understanding this breadth is necessary as we strive to deliver safe, high quality, family-centred pediatric care in this new era. As the pandemic continues, we need to consider carefully how to provide elective and ambulatory care, including surgery, in this era of social distancing. Particular attention is needed to understand particular aspects, including vulnerable children and the clinician experience of the COVID-19 pandemic.

scholarly journals The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

2015 ◽  
Vol 81 (9) ◽  
pp. 854-858 ◽  
Author(s):  
Rudy J. Judhan ◽  
Raquel Silhy ◽  
Kristen Statler ◽  
Mija Khan ◽  
Benjamin Dyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Tertiary Care ◽  
Disease Process ◽  
Pediatric Care ◽  
Care Hospital ◽  
Late Night ◽  
General Surgeons ◽  
The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

Characterizing Hospital Admissions to a Tertiary Care Hospital After Typhoon Haiyan

2016 ◽  
Vol 10 (2) ◽  
pp. 240-247 ◽  
Author(s):  
Mary P. Chang ◽  
Daren J. Simkin ◽  
Maria Lourdes de Lara ◽  
Thomas D. Kirsch
Keyword(s):  
Public Health ◽  
Motor Vehicle ◽  
Tertiary Care ◽  
The Philippines ◽  
Health Care Facilities ◽  
Care Hospital ◽  
Medical Diagnoses ◽  
Post Impact ◽  
Impact Phase ◽  
The Impact

AbstractObjectiveOn November 8, 2013, Typhoon Haiyan (Yolanda) made landfall in the Philippines. The literature characterizing the medical, surgical, and obstetrics burden following typhoons is lacking. This study aimed to improve disaster preparedness by analyzing medical diagnoses presenting to a city district hospital before, during, and after Typhoon Haiyan.MethodsThe assessment of disease burden and trends was based on logbooks from a local hospital and a nongovernmental organization field hospital for the medicine, surgical, and obstetrics wards before, during, and after the typhoon.ResultsThe hospital provided no services several days after typhoon impact, but there was an overall increase in patient admissions once the hospital reopened. An increase in gastroenteritis, pneumonia, tuberculosis, and motor vehicle collision-related injuries was seen during the impact phase. A dengue fever outbreak occurred during the post-impact phase. There was a noticeable shift in a greater percentage of emergent surgical cases performed versus elective cases during the impact and post-impact phases.ConclusionOverall, several public health measures can prevent the increase in illnesses seen after a disaster. To prepare for the nonfatal burden of disease after a typhoon, health care facilities should increase their resources to accommodate the surge in patient volume. (Disaster Med Public Health Preparedness. 2016;10:240–247)

scholarly journals 81. Children and COVID-19 in Colorado: The Children’s Hospital Colorado Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S172-S173
Author(s):  
Kelly E Graff ◽  
Lori Silveira ◽  
Jane Jarjour ◽  
Shane Curran-Hays ◽  
Lauren Carpenter ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Wide Spectrum ◽  
Severe Disease ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Logistic Regression Models ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in > 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children’s Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children. Methods We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values < 0.05 considered statistically significant. Results We identified 246 patients with SARS-CoV-2 (age range: 17 days-25 years). We noted a Hispanic predominance with 68% of all patients with SARS-CoV-2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0–3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004). Figure 3: Predictors for Admission and Respiratory Support Requirement in CHCO Patients with SARS-CoV-2 Conclusion There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children. Disclosures Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support)

VP147 Implementing Electronic Health Record In A Children's Hospital

2017 ◽  
Vol 33 (S1) ◽  
pp. 216-217
Author(s):  
Martina Andellini ◽  
Francesco Faggiano ◽  
Francesca Sabusco ◽  
Pietro Derrico ◽  
Matteo Ritrovato
Keyword(s):  
Electronic Health Record ◽  
Healthcare Delivery ◽  
Legal Aspects ◽  
Health Record ◽  
Privacy And Security ◽  
Children's Hospital ◽  
Organizational Outcome ◽  
Children’S Hospital ◽  
Electronic Health ◽  
The Impact

INTRODUCTION:Since the adoption of electronic health record (EHR) systems, which contain large volumes of aggregated longitudinal clinical data, promises a number of substantial benefits including better care, improved safety issues and decreased healthcare costs (1). It is also associated with significant costs and large technical and organizational impacts, therefore it is important to conduct comprehensive evaluations of healthcare delivery outcomes. The purpose of the study is to gather evidence on safety and overall effectiveness of EHR implementation in Bambino Gesù Children's Hospital (OPBG).METHODS:Decision-oriented HTA (DoHTA) method (2) was applied to assess the technology on clinical, technical, organizational, economic, legal, ethical and safety domains. It's a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel integrated with the Analytic Hierarchy Process. It allows defining an evaluation structure represented by a hierarchical decision tree filled by indicators of technology's performances, each of which was given a weight proportional to the impact that this criterion provides to achieve the purpose of the decision problem; finally, the alternatives’ ranking was defined.RESULTS:The multidisciplinary assessment took into consideration all of the aspects and recommendations about the benefits and disadvantages of EHR (3). The synthesis of scientific evidence integrated with results of the specific context analysis, resulted in the definition of components of the decisional hierarchy structure. In particular, EHR seems to offer many benefits in terms of safety and clinical effectiveness such as improved continuity and quality of care, and increased accessibility of the data. The implementation of EHR resulted in important organizational outcome such as EHR configuration, learning curve and training. For these reasons, the usability was the main technical characteristics of the technology taken into account. Finally, legal aspects on privacy and security of data, covered a key role in the assessment.CONCLUSIONS:A thorough evaluation of the EHR before its implementation has permitted hospital's decision makers to choose knowingly.

Nurse Leader Rounds: Effect on Nurse - Related Patient Satisfaction Scores on Two Post-Surgical Units in an Acute Care Facility

2017 ◽  
Vol 2 (3) ◽  
Keyword(s):  
Patient Satisfaction ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Patient Perception ◽  
Inpatient Setting ◽  
Care Hospital ◽  
Nurse Leader ◽  
Surgical Units ◽  
Significant Difference ◽  
The Impact

Background and Significance: The best possible inpatient experience is a priority for many hospitals in today’s model of healthcare delivery. Achieving and sustaining measurable success is a key challenge. Nurse leader rounds (NLR) has been revealed to be an effective improvement strategy in some hospitals. The purpose of this DNP project was to analyze the impact of implementing daily NLR on patient satisfaction (PS) scores in two postsurgical units at Mount Sinai Beth Israel (MSBI) hospital in New York. Methods: This study used descriptive comparison to analyze existing survey data before and after NLR was implemented. The study took place in an academic, urban, tertiary care hospital in two postsurgical units. Data were collected using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey reflecting questions to measure patient’s perceptions of care, specifically, assessing the nurse related communication to examine if there was a relationship between NLR and PS scores. Results: Patient perception data summarized in this study suggested that the implementation of NLR was associated with increased levels of patient satisfaction with communication (SC) with nurses following NLR in the inpatient setting on two post-surgical units. The results indicated significant difference between the pre and post scores of SC in nurse related questions referring to communication (Appendix A). Conclusion: Effective implementation of NLR can improve patient perception of care. Improvements in nurse communica

scholarly journals The impact of transforming healthcare delivery on cystic fibrosis outcomes: a decade of quality improvement at Cincinnati Children’s Hospital

2014 ◽  
Vol 23 (Suppl 1) ◽  
pp. i56-i63 ◽  
Author(s):  
Christopher M Siracusa ◽  
Jeanne L Weiland ◽  
James D Acton ◽  
Amitra K Chima ◽  
Barbara A Chini ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Quality Improvement ◽  
Healthcare Delivery ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

scholarly journals Impact of the COVID-19 pandemic on neonatal admissions in a tertiary children’s hospital in southwest China: An interrupted time-series study

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262202
Author(s):  
Weiqin Liu ◽  
Qifen Yang ◽  
Zhen-e Xu ◽  
Ya Hu ◽  
Yongming Wang ◽  
...  
Keyword(s):  
Time Series ◽  
Southwest China ◽  
Interrupted Time Series ◽  
Care Hospital ◽  
Health Seeking ◽  
Health Seeking Behavior ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Seeking Behavior ◽  
The Impact

Background The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures in a tertiary Children’s Hospital in southwest China, which might be used to predict long-term effects related to health-seeking behavior of parents/caregivers. Methods This study included newborns enrolled over a span of 86 weeks between January 4, 2019, and August 27, 2020. We designated two time periods for analysis purposes: a stable pre-COVID period(55 weeks between January 4, 2019, and January 23, 2020) and a COVID-impacted period (31 weeks between January 24, 2020, and August 27, 2020). An interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectra before and after the period of nonpharmaceutical interventions (NPIs). Furthermore, this study was conducted to evaluate whether the health-seeking behavior of parents/caregivers was influenced by pandemic factors. Results Overall, 16,640 infants were admitted to the neonatology department during the pre-COVID period (n = 12,082) and the COVID-impacted period (n = 4,558). The per week neonatal admissions consistently decreased following the first days of NPIs (January 24, 2020). The average weekly admission rates of 220/week pre-COVID period and 147/week COVID-impacted period. There was an evident decrease in the volume of admissions for all disease spectra after the intervention, whereas the decrease of patients complaining about pathological jaundice-related conditions was statistically significant (p<0.05). In the COVID-impacted period, the percentage of patients who suffered from respiratory system diseases, neonatal encephalopathy, and infectious diseases decreased, while the percentage of pathological jaundice-related conditions and gastrointestinal system diseases increased. The neonatal mortality rates (NMRs) increased by 8.7% during the COVID-impacted period compared with the pre-COVID period. Conclusions In summary, there was a significant decline in neonatal admissions in a tertiary care hospital during the COVID-19 Pandemic and the associated NPIs. Additionally, this situation had a remarkable impact on disease spectra and health-seeking behavior of parents/caregivers. We, therefore, advise continuing follow-ups and monitoring the main health indicators in vulnerable populations affected by this Pandemic over time.

The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

2019 ◽  
Vol 57 (2) ◽  
pp. 148-160 ◽  
Author(s):  
Amber D. Shaffer ◽  
Matthew D. Ford ◽  
Joseph E. Losee ◽  
Jesse Goldstein ◽  
Bernard J. Costello ◽  
...  
Keyword(s):  
Language Development ◽  
Cleft Palate ◽  
Outcome Measures ◽  
Tertiary Care ◽  
Language Delays ◽  
Language Outcomes ◽  
Speech And Language ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

Objective: To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate. Design: Retrospective case series. Setting: Tertiary care children’s hospital. Participants: Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children’s hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed. Interventions: Palatoplasty. Main Outcome Measures: Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery. Results: Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( P < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty. Conclusions: Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.

scholarly journals Length of Stay in the Emergency Department during COVID-19 Pandemic in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Suraj Singh ◽  
Bibek Koirala ◽  
Rabin Thami ◽  
Anupama Thapa ◽  
Bijay Thapa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Children's Hospital ◽  
Children’S Hospital

Introduction: Emergency Department overcrowding has become worsening problem internationally which may affect patient, emergency department efficiency and quality of care and this may lead to increased risk of in hospital mortality, higher costs, medical errors and longer times to treatment. With this pandemic COVID-19 likely to go on for months, if not a year or longer, the Emergency Department should be prepared for large influx of patients infected with COVID-19. The aim of this study is to find-out the length of stay in emergency department during COVID-19 pandemic at a tertiary care hospital in Nepal. Methods: This is a descriptive cross-sectional study conducted in the Emergency Department of Kanti Children’s Hospital. Ethical clearance was obtained from Institutional review committee Kanti Children’s Hospital. Data collection was done from the emergency records from July 23, 2020 to July 29, 2020. The calculated sample size was 211. The data thus obtained was entered in Statistical Package for the Social Science software version 20 and necessary calculations were done. Results: The median length of stay in emergency department was found to be 1.75 hours (Interquartile range 0 to 30 hours). Conclusions: Definitive management starts in respective wards and Intensive Care Units. During COVID-19, with longer emergency stay, chances of cross-infection increases, and the health workers serving in emergency department will be at risks. So guidelines for shorter emergency stay should be implemented.

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