Pandemic Brings Changes to Pediatric Care

Nurses caring for children nationwide witnessed major changes in pediatric care delivery because of the pandemic.

These changes include adapting to new hospital policies and communication and staffing models according to a study published October 11 in BMC Health Services Research.

The findings of the study can help guide hospital leaders in navigating the pandemic recovery and addressing future crises, the authors wrote.

2020: Catching Flaws in the System

Researchers interviewed a mix of administrators, front-line physicians, nurses, and parents from unidentified pediatric care and community hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates during the pandemic’s onset in 2020.

Analyzing the data from interviews with 30 participants at 12 hospitals, researchers found how leaders quickly changed hospital policies. Some set up command centers staffed with hospital leadership. Researchers also found that changes were facilitated by reviewing the data often and engaging stakeholders.

“We stood up a COVID command center in 2020 with the initial outbreak and in 2021 when we saw the increase in the Delta wave. We met every day at 9 [a.m.] and huddled …,” said Laurie Schulenberg, MPA/HCA, BSN, RN, NEA-BC, Interim Chief Nursing Officer at Children’s Hospital New Orleans. This facility had the highest rate of pediatric COVID-19 patients in the country during the summer of 2021, according to Schulenberg.

Nurses, including the planning chief and nursing supervisor, talked daily with other hospital leaders for updates on the hospital’s COVID-19 census, how many COVID-positive kids were in the emergency room, and how to address challenges, Schulenberg said.

“We had already come up with ideas in 2020 for the rare kids that we had with COVID — things like putting the IV pumps outside of the rooms [and] making sure we had enough negative pressure rooms,” she said.

While these command centers helped hospitals to make changes, they also served to expose process flaws. For example, the increased use of telehealth and videoconferencing in 2020 benefited physical distancing but created unique communication challenges with non-English speakers, according to the study.

“The COVID-19 pandemic resulted in widespread adoption of telemedicine, and in the inpatient setting, phone and video interpretation with reduced use of in-person interpreters to promote physical distancing,” study author Nicole Penwill, MD, MPH, FAAP, a University of California San Francisco (UCSF) Pediatric Hospital Medicine Fellow.

Several clinician participants in her study described added challenges and reduced communication quality using remote interpretation services.

“One participant described the notable challenge of trying to obtain a detailed medical history while wearing an N95, the air filtration machine running in the background, and over an interpreter,” Penwill said. “Some participants described growing comfort [and] familiarity with using remote translator services over the course of the pandemic and expansion of communication technology services at their hospital.”

Visitor Restrictions

Restricting visitors can be more challenging in pediatric care than in adult acute care.

There were federally mandated no-visitation policies implemented at all U.S. hospitals when the pandemic started, said Laura J. Wood, DNP, RN, NEA-BC, FAAN, EVP Patient Care Operations and System Chief Nursing Officer at …read more

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