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Hill K, McCabe C, Brenner M. Impact of adapting paediatric intensive care units for adult care during the COVID-19 pandemic: a scoping review. BMJ Open 2023; 13:e068174. [PMID: 37640456 PMCID: PMC10462976 DOI: 10.1136/bmjopen-2022-068174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES The objectives were to categorise the evidence, map out the existing studies and explore what was known about the organisation of paediatric intensive care units (PICUs) during the first 18 months of the COVID-19 pandemic. Additionally, this review set out to identify any knowledge gaps in the literature and recommend areas for future research. DESIGN Scoping review. METHODS This study used Arksey and O'Malley's six-stage scoping review framework. A comprehensive search was conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE and grey literature search engines. A search strategy with predefined inclusion criteria was used to uncover relevant research in this area. Screening and data collection were done in duplicate. RESULTS 47 631 articles were obtained through searching. However, only 25 articles met the inclusion criteria and were included in the analysis. Three dominant themes emerged from the literature: (1) the reorganisation of space for managing increased capacity; (2) increased staffing and support; and (3) the resulting challenges. CONCLUSION COVID-19 has strained institutional resources across the globe. To relieve the burden on intensive care units (ICUs), some PICUs adjusted their units to care for critically ill adults, with other PICUs making significant changes, including the redeployment of staff to adult ICUs to provide extra care for adults. Overall, PICUs were collectively well equipped to care for adult patients, with care enhanced by implementing elements of holistic, family-centred PICU practices. The pandemic fostered a collaborative approach among PICU teams and wider hospital communities. However, specific healthcare guidelines had to be created to safely care for adult patients.
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Affiliation(s)
- Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Catherine McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Conlon C, McDonnell T, Barrett M, Cummins F, Deasy C, Hensey C, McAuliffe E, Nicholson E. The impact of the COVID-19 pandemic on child health and the provision of Care in Paediatric Emergency Departments: a qualitative study of frontline emergency care staff. BMC Health Serv Res 2021; 21:279. [PMID: 33766026 PMCID: PMC7993902 DOI: 10.1186/s12913-021-06284-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system. Methods Fifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians (n = 5), nursing managerial staff (n = 6), social workers (n = 2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes. Results The pandemic and public health restrictions have had an adverse impact on children’s health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care. Conclusions The spread of COVID-19 and subsequent policies to address the pandemic has had wide-reaching implications for children’s health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06284-9.
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Affiliation(s)
- Ciara Conlon
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Thérèse McDonnell
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Barrett
- Children's Health Ireland at Crumlin, Dublin; Women's and Children's Health, School of Medicine, University College Dublin; National Children's Research Centre, Dublin, Ireland
| | - Fergal Cummins
- REDSPOT, Emergency Department, Limerick University Hospital, Limerick, Ireland
| | | | - Conor Hensey
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Emma Nicholson
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
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Chelo D, Mekone Nkwelle I, Nguefack F, Mbassi Awa HD, Enyama D, Nguefack S, Noukeu Njinkui D, Tony Nengom J, Nguefack-Tsague G, Koki Ndombo PO. Decrease in Hospitalizations and Increase in Deaths during the Covid-19 Epidemic in a Pediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months. Fetal Pediatr Pathol 2021; 40:18-31. [PMID: 33078968 DOI: 10.1080/15513815.2020.1831664] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The COVID-19 pandemic reached Cameroon in March, 2020. The aim of this study was to unveil the consequences of this pandemic on hospitalizations and on mortality in a pediatric hospital. Methods: A descriptive and retrospective cross-sectional study was carried out using hospitalization and death statistics collected from a pediatric hospital. We compared the data before and after the pandemic and made predictions for the next 12 months. Results: A drastic drop in hospitalizations was noted coinciding with the partial lockdown in Cameroon. Paradoxically, at the same time, the number of deaths per month doubled though the causes remained the same as in the past. Conclusion: The COVID-19 pandemic was marked by drop in hospitalizations and paradoxically, an increase in child mortality. These deaths were probably due not to SARS-Cov-2 infection, but rather due to the usual illnesses whose management was delayed, a probable consequence of the confinement.
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Affiliation(s)
- David Chelo
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Isabelle Mekone Nkwelle
- Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Félicitée Nguefack
- Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Hubert Désiré Mbassi Awa
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Dominique Enyama
- Faculty de Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroun
| | - Séraphin Nguefack
- Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Diomède Noukeu Njinkui
- Faculty de Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroun
| | - Jocelyn Tony Nengom
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Georges Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Paul Olivier Koki Ndombo
- Mother and Child Center, Chantal BIYA Foundation, Yaoundé, Cameroon.,Department de Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
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McDonnell T, Nicholson E, Conlon C, Barrett M, Cummins F, Hensey C, McAuliffe E. Assessing the Impact of COVID-19 Public Health Stages on Paediatric Emergency Attendance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186719. [PMID: 32942698 PMCID: PMC7558983 DOI: 10.3390/ijerph17186719] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 01/29/2023]
Abstract
This study outlines the impact of COVID-19 on paediatric emergency department (ED) utilisation and assesses the extent of healthcare avoidance during each stage of the public health response strategy. Records from five EDs and one urgent care centre in Ireland, representing approximately 48% of national annual public paediatric ED attendances, are analysed to determine changes in characteristics of attendance during the three month period following the first reported COVID-19 case in Ireland, with reference to specific national public health stages. ED attendance reduced by 27–62% across all categories of diagnosis in the Delay phase and remained significantly below prior year levels as the country began Phase One of Reopening, with an incident rate ratio (IRR) of 0.58. The decrease was predominantly attributable to reduced attendance for injury and viral/viral induced conditions resulting from changed living conditions imposed by the public health response. However, attendance for complex chronic conditions also reduced and had yet to return to pre-COVID levels as reopening began. Attendances referred by general practitioners (GPs) dropped by 13 percentage points in the Delay phase and remained at that level. While changes in living conditions explain much of the decrease in overall attendance and in GP referrals, reduced attendance for complex chronic conditions may indicate avoidance behaviour and continued surveillance is necessary.
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Affiliation(s)
- Thérèse McDonnell
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
- Correspondence: ; Tel.: +353-1-716-6689
| | - Emma Nicholson
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
| | - Ciara Conlon
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
| | - Michael Barrett
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland;
- Women’s and Children’s Health, School of Medicine, University College Dublin, D04 C7X2 Dublin, Ireland
- National Children’s Research Centre, D12 N512 Dublin, Ireland
| | - Fergal Cummins
- REDSPOT (Retrieval, Emergency and Disaster Medicine Research and Development), Emergency Department, Limerick University Hospital, V94 F858 Limerick, Ireland;
| | - Conor Hensey
- Children’s Health Ireland at Temple Street, D01 XD99 Dublin, Ireland;
| | - Eilish McAuliffe
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
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