Volume 56, Issue S2 p. 51
SPECIAL ISSUE ABSTRACT

Quality and Safety Challenges in Inpatient Pediatric Care during the COVID-19 Pandemic: A National Qualitative Study

Nadia Roessler De Angulo

Corresponding Author

Nadia Roessler De Angulo

University of California, San Francisco, San Francisco, California, USA

Correspondence

Nadia Roessler De Angulo

Email: [email protected]

Search for more papers by this author
Nicole Penwill

Nicole Penwill

University of California, San Francisco, San Francisco, California, USA

Search for more papers by this author
Priya Pathak

Priya Pathak

University of California, San Francisco, San Francisco, California, USA

Search for more papers by this author
Martha Elster

Martha Elster

University of California, San Francisco, San Francisco, California, USA

Search for more papers by this author
Clairissa Ja

Clairissa Ja

University of California, Davis, Davis, California, USA

Search for more papers by this author
Daniela Hochreiter

Daniela Hochreiter

Yale University, New Haven, Connecticut, USA

Search for more papers by this author
Karen Wilson

Karen Wilson

Mount Sinai Kravis Children's Hospital, New York, New York, USA

Search for more papers by this author
Jacqueline Newton

Jacqueline Newton

Children's National Hospital, Washington, District of Columbia, USA

Search for more papers by this author
Sunitha Kaiser

Sunitha Kaiser

University of California, San Francisco, San Francisco, California, USA

Search for more papers by this author
First published: 15 September 2021

Abstract

Research Objective

The COVID-19 pandemic has necessitated rapid changes in healthcare delivery, including surge planning and modifying healthcare delivery environments and practices. Our objective was to identify the major resulting challenges for quality and safety of pediatric inpatient care.

Study Design

We conducted semi-structured video interviews. Using constant comparative methods, we iteratively coded data to identify themes related to pediatric inpatient quality and safety challenges during the pandemic.

Population Studied

We purposefully sampled from community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 front-line clinicians per site (mix of administrators, nurses, physicians).

Principal Findings

Twenty-four participants from 12 hospitals were interviewed. The most commonly encountered themes are detailed in Table 1. Changes in healthcare delivery practices potentially impacting quality and safety of inpatient pediatric care included: 1) limits on family and caregiver visitation, which may have hindered gathering important details for diagnosis and engaging in shared-decision making about management; 2) personal protective equipment and isolation practices, which may have compromised effective communication with caregivers and interpreters; 3) changes in quality improvement (QI) infrastructure and activities, with potential decreases in monitoring and safety efforts; 4) difficulties defining and providing high-quality care for children with COVID-19 and multi-system inflammatory syndrome in children, both novel diagnoses; and 5) potential increases in safety events due to decreased direct contact with patients and monitoring (e.g., wound infections, central line-associated bloodstream infections and catheter-associated urinary tract infections).

TABLE 1.
Theme Exemplary Quote
Limiting family or caregiver visitation “In challenging diagnoses, even if it wasn't COVID-related, you couldn't have both parents there at the same time.”
Experiencing personal protective equipment or isolation status as a barrier to communication “With non-English speaking parents, we were trying to use an interpreter phone with an N9, an extra mask, the negative pressure circulator running in the background. Trying to get a good history and to provide quality care was really brutal.”
Difficulty maintaining high-quality care “These people would not have any care. They would be sitting in the ED in the hallway, one ED doc taking care of 50 patients. No, you were not qualified to take care of this patient, but this is a pandemic.”
Changes in QI operations (staffing, data monitoring, QI activities) “Everything non-essential stopped. Meetings canceled, research on hold, IRB halted, labs shut down. We have mandatory reporting on things like sepsis. There was too much else going on, we stopped measuring certain things.”
Increasing healthcare-associated safety events or harms “We had an uptake in our CLABSI, in every healthcare-associated condition we were capable of tracking. After the fact, because that was not the priority.”

Conclusions

This national qualitative study of early COVID-19 epicenters described changes in several domains of healthcare delivery affecting quality and safety of pediatric inpatient care.

Implications for Policy or Practice

The several potential areas of focus identified can help clinicians and hospital leaders plan for safe and high-quality care for hospitalized children, during this ongoing crisis and for future pandemics.

Primary Funding Source

Agency for Healthcare Research and Quality.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.