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Park JH, Lee MJ, Tsai MH, Shih HJ, Chang J. Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS). Patient Prefer Adherence 2023; 17:3477-3487. [PMID: 38143946 PMCID: PMC10749101 DOI: 10.2147/ppa.s439437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Min Jee Lee
- Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Huan-Ju Shih
- Department of Health Administration and Policy, School of Public Health, George Mason University, Fairfax, VA, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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Foster JR, Lee LA, Seabrook JA, Ryan M, Slumkoski C, Walls M, Betts LJ, Burgess SA, Moghadam N, Garros D. A survey of pediatric intensive care unit clinician experience with restricted family presence during COVID-19. Can J Anaesth 2023; 70:1669-1681. [PMID: 37610552 PMCID: PMC10600297 DOI: 10.1007/s12630-023-02547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/23/2023] [Accepted: 03/13/2023] [Indexed: 08/24/2023] Open
Abstract
PURPOSE Limiting family presence runs counter to the family-centred values of Canadian pediatric intensive care units (PICUs). This study explores how implementing and enforcing COVID-19-related restricted family presence (RFP) policies impacted PICU clinicians nationally. METHODS We conducted a cross-sectional, online, self-administered survey of Canadian PICU clinicians to assess experience and opinions of restrictions, moral distress (Moral Distress Thermometer, range 0-10), and mental health impacts (Impact of Event Scale [IES], range 0-75 and attributable stress [five-point Likert scale]). For analysis, we used descriptive statistics, multivariate regression modelling, and a general inductive approach for free text. RESULTS Representing 17/19 Canadian PICUs, 368 of 388 respondents (94%) experienced RFP policies and were predominantly female (333/368, 91%), English speaking (338/368, 92%), and nurses (240/368, 65%). The mean (standard deviation [SD]) reported moral distress score was 4.5 (2.4) and was associated with perceived differential impact on families. The mean (SD) total IES score was 29.7 (10.5), suggesting moderate traumatic stress with 56% (176/317) reporting increased/significantly increased stress from restrictions related to separating families, denying access, and concern for family impacts. Incongruence between RFP policies/practices and PICU values was perceived by 66% of respondents (217/330). Most respondents (235/330, 71%) felt their opinions were not valued when implementing policies. Though respondents perceived that restrictions were implemented for the benefit of clinicians (252/332, 76%) and to protect families (236/315, 75%), 57% (188/332) disagreed that their RFP experience was mainly positive. CONCLUSION Pediatric intensive care unit-based RFP rules, largely designed and implemented without bedside clinician input, caused increased psychological burden for clinicians, characterized as moderate moral distress and trauma triggered by perceived impacts on families.
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Affiliation(s)
- Jennifer R Foster
- Department of Pediatric Critical Care, IWK Health Centre, 5850/5980 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada.
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada.
- Department of Pediatrics, Western University, London, ON, Canada.
- Children's Health Research Institute and Lawson Health Research Institute, London, ON, Canada.
| | - Laurie A Lee
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Critical Care, Alberta Children's Hospital, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jamie A Seabrook
- Department of Pediatrics, Western University, London, ON, Canada
- Children's Health Research Institute and Lawson Health Research Institute, London, ON, Canada
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
- Human Environments Analysis Laboratory, Western University, London, ON, Canada
| | - Molly Ryan
- Department of Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada
| | - Corey Slumkoski
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Martha Walls
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Laura J Betts
- Department of Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada
| | - Stacy A Burgess
- Department of Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada
- Children's Health Program, IWK Health, Halifax, NS, Canada
| | - Neda Moghadam
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Daniel Garros
- Stollery Children's Hospital, Pediatric Intensive Care Unit, Edmonton, AB, Canada
- Division of Critical Care, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Wolfe I, Moore B, Bush L, Knackstedt A, Derrington S, Hoehn KS, Johnson LM, Porter S, Brown AC. Antiracism: An Ethical Imperative. Pediatrics 2023; 152:e2022059804. [PMID: 37560789 DOI: 10.1542/peds.2022-059804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 08/11/2023] Open
Abstract
Pediatric ethicists hold a privileged position of influence within health care institutions. Such a position confers a corresponding responsibility to address barriers to the health and flourishing of all children. A major barrier to children's health is racism. Pediatric ethicists can, and should, leverage their position to address racism both in institutional policy and the provision of pediatric care. Health care's historical and continued contributions to fostering and sustaining racist values and systems mean that those within all medical fields- regardless of race, ethnicity, gender, age, or profession-should consider ways they can work to offset and ultimately dismantle those values and systems. Institutional policy is a critical mechanism propagating racism in hospitals and an area where ethicists have a unique perspective to bring antiracism into ethical analysis. Many institutional and organizational policies have unintended consequences, negatively impacting children and families who have been historically marginalized and oppressed. In this paper, we report and discuss existing policies, along with how they are implemented (procedures) and how they are conducted (practices), identified through a workshop during a pediatric subgroup meeting at an annual bioethics conference. We highlight the need to focus on these structural factors and reference scholarship that can be used to correct institutional policies that uphold white supremacy. We conclude with actionable, concrete recommendations for change.
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Affiliation(s)
- Ian Wolfe
- Clinical Ethics Department, Children's Minnesota, Minneapolis, Minnesota
- Center for Bioethics, University of Minnesota, Minneapolis, Minnesota
| | - Bryanna Moore
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, Texas
| | - Lynn Bush
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Sabrina Derrington
- Children's Hospital Los Angeles Center for Bioethics, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - K Sarah Hoehn
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | | | - Sarah Porter
- Randall Children's Hospital, Portland, Oregon
- Portland State University, Portland, Oregon
| | - Amy Caruso Brown
- Center for Bioethics and Humanities
- Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse, New York
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Georgousopoulou V, Voutetakis A, Galanis P, Kourti FE, Zartaloudi A, Koutelekos I, Dousis E, Kosmidis D, Koutsouki S, Pappa D, Igoumenidis M, Dafogianni C. Assessing the Respect of Children's Rights in Pediatric Hospitals. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050955. [PMID: 37241187 DOI: 10.3390/medicina59050955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: In 1989, the United Nations (UN) General Assembly adopted the United Nations Convention on the Rights of the Child (UNCRC), with a considerable number of the Articles of the Convention being related to the health status of children. Therefore, adhering to and assessing the implementation of the rights of children during hospitalization is a very important step towards child protection. Herein, we attempt to highlight the depth of knowledge of employees working in children's hospitals with regard to children's rights as well as the degree of adherence to the UNCRC with respect to hospitalized children. Material and Methods: The target group included all healthcare professionals working in the various general pediatric clinics of the three Children's Hospitals of the Athens metropolitan area in Greece. We conducted a cross-sectional study, with data collection carried out in February and March 2020, using a structured questionnaire consisting of 46 questions which was handed out to all personnel. For the analysis, we used the IBM SPSS 21.0. Results: A total of 251 individuals participated in the study (physicians 20%, nurses 72%, and other employees 8%). A total of 54.5% of health professionals did not know what the UNCRC is, and 59.6% of them were not even aware that their hospital had rules and a bioethical committee related to clinical research involving children. Lack of awareness or trust of health professionals is also observed for other procedures or supervisory measures such as abuse protocols, complaint control, admission control, etc. With regard to the health system, there are shortcomings or weaknesses in (a) procedures followed with regard to respect for gender and privacy, (b) information on basic services provided by pediatric hospitals (such as recreation, education and free meals during hospitalization), (c) the logistical infrastructure (such as recreational facilities and facilities for the disabled), (d) the possibility of recording complaints, and (e) hospitalizations that were not necessary. A difference emerged concerning the nurses' responses between the three hospitals, with nurses participating in relevant seminars held in one of the hospitals being significantly more informed. Conclusions: The majority of healthcare personnel seem unaware of basic principles with respect to children's rights during hospitalization as well as relevant procedures and supervisory measures. Moreover, obvious weaknesses of the health system exist with respect to procedures, services, infrastructure, and complaint recording. There is a need for improved education of health professionals with respect to the implementation of children's rights in pediatric hospitals.
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Affiliation(s)
- Vasiliki Georgousopoulou
- 1st Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Antonis Voutetakis
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | | | - Evangelos Dousis
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - Dimitrios Kosmidis
- Department of Nursing, International Hellenic University, 68300 Didimoteixo, Greece
| | - Sotiria Koutsouki
- Department of Nursing, General Hospital of Kavala, 65500 Kavala, Greece
| | - Despoina Pappa
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - Michael Igoumenidis
- Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, 26334 Patras, Greece
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Vo H, Campelia GD, Olszewski AE. Addressing Racism in Ethics Consultation: An Expansion of the Four-Box Method. THE JOURNAL OF CLINICAL ETHICS 2023; 34:11-26. [PMID: 36940357 DOI: 10.1086/723322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractRacism is a pervasive issue in patient care and a key social determinant of health. Clinical ethicists, like others involved in patient care, have a duty to recognize and respond to racism on both individual and systems-wide levels to improve patient care. Doing so can be challenging and, like other skills in ethics consultation, may benefit from specialized training, standardized tools and approaches, and practice. Learning from existing frameworks and tools, as well as building new ones, can help guide clinical ethicists to systematically approach racism as it affects clinical cases. Here, we propose an expansion of the commonly used four-box method to clinical ethics consultation, where racism is considered as a potential factor in each of the four boxes. We apply this method to two clinical cases to highlight ethically salient information that might be missed using the standard formulation of the four boxes but captured with the expanded version. We argue that this expansion of an existing clinical ethics consultation tool is ethically justified insofar as it (a) creates a more just approach, (b) supports individual consultants and services, and (c) facilitates communication in contexts where racism impinges on effecting good patient care.
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6
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Baumbusch J, Lloyd JEV, Lamden-Bennett SR, Ou C. The unintended consequences of COVID-19 public health measures on health care for children with medical complexity. Child Care Health Dev 2022; 48:970-978. [PMID: 35043430 DOI: 10.1111/cch.12968] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this work is to explore the unintended consequences of pandemic public health measures on health care service usage by children with medical complexity. BACKGROUND Medical complexity is characterized by the presence of complex, chronic conditions requiring specialized care, substantial health needs, functional dependence and/or limitations, and frequent health care usage. Children with medical complexity are among the highest users of paediatric health care services. METHODS A web-based, cross-sectional survey was conducted in British Columbia, Canada, between August and September 2020. Inclusion criteria were (a) parent/guardian of at least one child (age 0 to 18 years, inclusive) with medical complexity and (b) residence in British Columbia. A convenience sample of 156 parents completed the survey. Data were analysed using a series of descriptive analyses (frequencies, cross-tabulations) and inferential analyses (binary logistic regressions). RESULTS Respondents provided information for 188 children with medical complexity. Access to allied health therapies (physio, occupational, and speech and language) and medical specialists drastically declined in the initial months of the pandemic, with a shift from in-person to virtual platforms for these aspects of care. Regression modelling indicated that age and family structure influenced decisions to use in-patient hospital services. CONCLUSIONS Public health measures implemented in the initial months of the pandemic decreased access to health care services for children with medical complexity. The long-term ramifications of these measures are unknown. Family structure was found to influence decisions to avoid accessing Emergency Department care. Given the volume of services used by these children, paediatric hospital leaders need to take their unique needs into consideration in disaster planning to ensure minimal disruptions in care.
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Affiliation(s)
- Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer E V Lloyd
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Christine Ou
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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7
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Eisman AB, Kim B, Salloum RG, Shuman CJ, Glasgow RE. Advancing rapid adaptation for urgent public health crises: Using implementation science to facilitate effective and efficient responses. Front Public Health 2022; 10:959567. [PMID: 36091566 PMCID: PMC9448975 DOI: 10.3389/fpubh.2022.959567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Responding rapidly to emerging public health crises is vital to reducing their escalation, spread, and impact on population health. These responses, however, are challenging and disparate processes for researchers and practitioners. Researchers often develop new interventions that take significant time and resources, with little exportability. In contrast, community-serving systems are often poorly equipped to properly adopt new interventions or adapt existing ones in a data-driven way during crises' onset and escalation. This results in significant delays in deploying evidence-based interventions (EBIs) with notable public health consequences. This prolonged timeline for EBI development and implementation results in significant morbidity and mortality that is costly and preventable. As public health emergencies have demonstrated (e.g., COVID-19 pandemic), the negative consequences often exacerbate existing health disparities. Implementation science has the potential to bridge the extant gap between research and practice, and enhance equity in rapid public health responses, but is underutilized. For the field to have a greater "real-world" impact, it needs to be more rapid, iterative, participatory, and work within the timeframes of community-serving systems. This paper focuses on rapid adaptation as a developing implementation science area to facilitate system responses during public health crises. We highlight frameworks to guide rapid adaptation for optimizing existing EBIs when responding to urgent public health issues. We also explore the economic implications of rapid adaptation. Resource limitations are frequently a central reason for implementation failure; thus, we consider the economic impacts of rapid adaptation. Finally, we provide examples and propose directions for future research and application.
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Affiliation(s)
- Andria B. Eisman
- Community Health, Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI, United States,Center for Health and Community Impact (CHCI), Wayne State University, Detroit, MI, United States,*Correspondence: Andria B. Eisman
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Clayton J. Shuman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, United States
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Bludau A, Heinemann S, Mardiko AA, Kaba HEJ, Leha A, von Maltzahn N, Mutters NT, Leistner R, Mattner F, Scheithauer S. Infection control strategies for patients and accompanying persons during the COVID-19 pandemic in German hospitals: a cross-sectional study in March-April 2021. J Hosp Infect 2022; 125:28-36. [PMID: 35413422 PMCID: PMC8994401 DOI: 10.1016/j.jhin.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients are at risk of nosocomial COVID-19 infection. The role of accompanying persons/visitors as potential infection donors is not yet well researched, but the risk will be influenced by prevention measures recommended by infection control practitioners. AIM To collect information about COVID-19 infection control strategies for patients and accompanying persons from infection control practitioners in German hospitals. METHODS A cross-sectional questionnaire was developed, ethically approved, pre-tested and formatted as an online tool. Infection control practitioners in 987 randomly selected German hospitals were invited to participate in March and April 2021. For statistical analysis, the hospitals were categorized as small (0-499 beds) or large (≥500 beds). FINDINGS One hundred surveys were completed (response rate: 10%). A higher proportion of large (71%) than small (49%) hospitals let patients decide freely whether to wear medical or FFP2 masks. Most hospitals reported spatial separation for COVID-19 patients and non-COVID-19 cases (38%) or additionally for suspected COVID-19 cases (53%). A separation of healthcare teams for these areas existed in 54% of the hospitals. Accompaniment bans were more prevalent in large (52%) than in small hospitals (29%), but large hospitals granted more exemptions. CONCLUSION The decision as to whether to separate areas and teams seemed to depend on the hospital's structural conditions, therefore impairing the implementation of recommendations. Accompaniment regulations differ between hospital sizes and may depend on patient numbers, case type/severity and patients' requirements. In the dynamic situation of a pandemic, it can be difficult to stay up to date with findings and recommendations on infection control.
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Affiliation(s)
- A Bludau
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany.
| | - S Heinemann
- Local Task Force of the Network University Medicine (NUM), University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany; Department of General Practice, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A A Mardiko
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - H E J Kaba
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A Leha
- Department of Medical Statistics, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - N von Maltzahn
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany
| | - N T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - R Leistner
- Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - F Mattner
- Institute for Hygiene, Cologne Merheim Medical Centre, University Witten-Herdecke, Cologne, Germany
| | - S Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
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Foster JR, Lee LA, Seabrook JA, Ryan M, Betts LJ, Burgess SA, Slumkoski C, Walls M, Garros D. Family presence in Canadian PICUs during the COVID-19 pandemic: a mixed-methods environmental scan of policy and practice. CMAJ Open 2022; 10:E622-E632. [PMID: 35790228 PMCID: PMC9262350 DOI: 10.9778/cmajo.20210202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite their broad commitment to family-centred care, children's hospitals and associated pediatric intensive care units (PICUs) restricted family presence during the COVID-19 pandemic. This study aimed to describe family presence policies and practices in Canadian PICUs from March to May 2020, and their evolution by August to December 2020. METHODS We conducted an environmental scan of family presence policies and restrictions in all 19 Canadian PICUs using 2 methods. We conducted a literature review of public-facing visitation policy documents in June 2020 using a standardized data extraction form. We also administered a cross-sectional survey of PICU leadership (managers and physician chiefs) between August and December 2020 by telephone or videoconferencing. We used inductive content analysis to code qualitative data, generating summative count data. We analyzed quantitative data descriptively. RESULTS As part of the literature search, we collected 2 (12%) PICU-specific, 14 (82%) pediatric-specific and 1 (6%) hospital-wide visitation policy documents from the early pandemic. One policy document provided guidance on all of the policy elements sought; the number of enabled caregivers was not included in the documents for 7 of 19 units (37%). All 19 Canadian PICUs were represented among the 24 survey respondents (15 physician chiefs and 9 operations or clinical managers). Before the COVID-19 pandemic, all units allowed the presence of 2 or more family members. Early in the pandemic, reported practices limited the number of adult caregivers for patients without SARS-CoV-2 infection to 1 (n = 21/24, 88%) or 2 (n = 3/24, 12%); all units prohibited siblings. Some centres restricted caregivers from switching bedside presence with one another (patients without SARS-CoV-2 infection: n = 16/23, 70%; patients with confirmed or suspected SARS-CoV-2 infection: n = 20/23, 87%); leaving their child's PICU room (patients without SARS-CoV-2 infection: n = 1/24, 4%; patients with confirmed or suspected SARS-CoV-2 infection: n = 16/24, 67%); and joining in-person rounds (patients without SARS-CoV-2 infection: n = 9/22, 41%; patients with confirmed or suspected SARS-CoV-2 infection: n = 17/22, 77%). All respondents endorsed policy exceptions during end-of-life care. Some reported policies and practices were adapted over the study period. INTERPRETATION Early COVID-19-related family presence policies in Canadian PICUs varied among centres. Although some centres adapted policies and practices, this study revealed ongoing potential threats to family centred care at the mid-pandemic stage.
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Affiliation(s)
- Jennifer Ruth Foster
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta.
| | - Laurie A Lee
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Jamie A Seabrook
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Molly Ryan
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Laura J Betts
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Stacy A Burgess
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Corey Slumkoski
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Martha Walls
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
| | - Daniel Garros
- Department of Pediatric Critical Care (Foster, Ryan, Betts, Burgess), Children's Health Program (Burgess), and patient partners, Department of Pediatric Critical Care (Slumkoski, Walls), IWK Health, Halifax, NS; Department of Critical Care (Foster), Dalhousie University, Halifax, NS; Faculty of Nursing (Lee), and Department of Pediatrics (Lee), Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University College, and Children's Health Research Institute (Seabrook), London, Ont.; Stollery Children's Hospital (Garros), Pediatric Intensive Care Unit; Division of Critical Care (Garros), Department of Pediatrics, University of Alberta, Edmonton, Alta
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10
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Impact of Coronavirus Disease-2019 on Hospital Care for Neonatal Opioid Withdrawal Syndrome. J Pediatr 2022; 245:47-55. [PMID: 35131283 PMCID: PMC8816795 DOI: 10.1016/j.jpeds.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare prenatal exposures, hospital care processes, and hospitalization outcomes for opioid-exposed newborns before and during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN In this multicenter retrospective analysis, data were collected from 19 Massachusetts hospitals, including 5 academic and 14 community hospitals. The pre-COVID-19 cohort was defined as births occurring during March 1, 2019-February 28, 2020, and the COVID-19 cohort was defined as births occurring during March 1, 2020-December 31, 2020. Opioid-exposed newborns born at ≥35 weeks of gestation were included. Differences in prenatal substance exposures, hospital care processes, and neonatal opioid withdrawal syndrome (NOWS) outcomes, including pharmacologic treatment for NOWS (PharmTx), length of stay (LOS), and as-needed (prn) treatment failure rates, were evaluated. RESULTS There were 663 opioid-exposed newborns in the pre-COVID-19 group and 476 in the COVID-19 group. No between-group differences were seen in prenatal substance exposures or the need for PharmTx. Compared with the pre-COVID-19 group, in the COVID-19 group there was less rooming-in after maternal discharge (53.8% vs 63.0%; P = .001) and less care in the pediatric unit setting (23.5% vs 25.3%; P = .001), longer LOS (adjusted risk ratio, 1.04; 95% CI, 1.01-1.08), and a higher rate of breast milk receipt at discharge (aOR, 2.03; 95% CI, 1.22-3.39). Within the subset of academic centers, more infants failed prn treatment in the COVID-19 group (53.8% vs 26.5%, P = .02; aOR, 3.77; 95% CI, 0.98-14.5). CONCLUSIONS Among the hospitals in our collaborative, hospital processes for NOWS, including care setting, rooming-in, and LOS were negatively impacted in the COVID-19 group, particularly in academic medical centers.
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11
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Vance AJ, Malin KJ, Benjamin A, Shuman CJ, Moore TA, Costa DK. Pandemic visitor policies: Parent reactions and policy implications. Acta Paediatr 2022; 111:604-606. [PMID: 34874577 DOI: 10.1111/apa.16208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ashlee J. Vance
- Center for Health Policy and Health Services Research Henry Ford Health System Detroit Michigan USA
| | - Kathryn J. Malin
- Children's Hospital of Wisconsin College of Nursing Marquette University Milwaukee Wisconsin USA
| | | | - Clayton J. Shuman
- School of Nursing Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA
| | - Tiffany A. Moore
- College of Nursing University of Nebraska Medical Center Omaha Nebraska USA
| | - Deena K. Costa
- School of Nursing Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA
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12
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McBride DL. The Impact of Visiting Restrictions During the COVID-19 Pandemic on Pediatric Patients. J Pediatr Nurs 2021; 61:436-438. [PMID: 34538537 PMCID: PMC8423989 DOI: 10.1016/j.pedn.2021.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022]
Abstract
Visitor restriction policies have been implemented on many hospital units as a result of the Covid-19 pandemic. These policies are integral to the strategies that hospitals are using to limit exposure risks during the pandemic. However, visitor restriction policies disproportionally affect hospitalized children. The trauma caused by lack of family at the bedside of adult patients during the Covid-19 pandemic has been studied but there is a lack of primary research on the impact of the Covid-19 visiting policy restrictions on pediatric patients. Long term studies are needed to understand the effect of this separation on children and their caregivers.
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