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National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

BACKGROUND: The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric inten...

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Autores principales: Abulebda, Kamal, Ahmed, Rami A, Auerbach, Marc A, Bona, Anna M, Falvo, Lauren E, Hughes, Patrick G, Gross, Isabel T, Sarmiento, Elisa J, Barach, Paul R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754533/
https://www.ncbi.nlm.nih.gov/pubmed/33384950
http://dx.doi.org/10.5492/wjccm.v9.i5.74
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author Abulebda, Kamal
Ahmed, Rami A
Auerbach, Marc A
Bona, Anna M
Falvo, Lauren E
Hughes, Patrick G
Gross, Isabel T
Sarmiento, Elisa J
Barach, Paul R
author_facet Abulebda, Kamal
Ahmed, Rami A
Auerbach, Marc A
Bona, Anna M
Falvo, Lauren E
Hughes, Patrick G
Gross, Isabel T
Sarmiento, Elisa J
Barach, Paul R
author_sort Abulebda, Kamal
collection PubMed
description BACKGROUND: The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections. AIM: To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide. METHODS: A cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation. RESULTS: We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives. CONCLUSIONS: A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.
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spelling pubmed-77545332020-12-30 National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic Abulebda, Kamal Ahmed, Rami A Auerbach, Marc A Bona, Anna M Falvo, Lauren E Hughes, Patrick G Gross, Isabel T Sarmiento, Elisa J Barach, Paul R World J Crit Care Med Retrospective Study BACKGROUND: The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections. AIM: To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide. METHODS: A cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation. RESULTS: We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives. CONCLUSIONS: A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves. Baishideng Publishing Group Inc 2020-12-18 /pmc/articles/PMC7754533/ /pubmed/33384950 http://dx.doi.org/10.5492/wjccm.v9.i5.74 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Study
Abulebda, Kamal
Ahmed, Rami A
Auerbach, Marc A
Bona, Anna M
Falvo, Lauren E
Hughes, Patrick G
Gross, Isabel T
Sarmiento, Elisa J
Barach, Paul R
National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
title National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
title_full National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
title_fullStr National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
title_full_unstemmed National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
title_short National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
title_sort national preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754533/
https://www.ncbi.nlm.nih.gov/pubmed/33384950
http://dx.doi.org/10.5492/wjccm.v9.i5.74
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