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Quality and Safety in Hospital Pediatrics During COVID-19: A National Qualitative Study
Nadia Roessler De Angulo1, Nicole Penwill1, Priya R Pathak1
1University of California, San Francisco, California.
Insights
The coronavirus disease 2019 (COVID-19) pandemic created significant challenges in pediatric inpatient quality and safety. Key issues included disrupted clinical workflows, communication barriers, and operational strains, impacting patient care and safety outcomes.
Area of Science:
- Pediatric Healthcare
- Quality Improvement
- Pandemic Preparedness
Background:
- The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted healthcare systems globally.
- Inpatient pediatric care faced unique challenges due to the pandemic's impact on clinical workflows and hospital operations.
Purpose of the Study:
- To describe the challenges encountered in inpatient pediatric quality and safety during the COVID-19 pandemic.
- To identify key areas for improvement in pediatric healthcare during and after public health crises.
Main Methods:
- A qualitative study involving semistructured interviews with healthcare professionals and caregivers.
- Participants were recruited from community and children's hospitals in high-COVID-19 hospitalization rate states.
- Constant comparative methods were used to analyze interview data and identify themes.
Main Results:
- Impacts on clinical workflows included reduced patient interactions and communication difficulties, partially mitigated by telehealth.
- Hospital operations were affected by changes in quality monitoring, increased health risks for staff, and shortages of personnel and supplies.
- Concerns were raised about increased risks of safety events, readmissions, and decreased patient satisfaction.
Conclusions:
- The COVID-19 pandemic presented substantial challenges to inpatient pediatric quality and safety.
- Findings underscore the need for focused strategies to manage pandemic-related disruptions and enhance future preparedness.
- Further research is recommended to address quality and safety in pediatric inpatient settings during health crises.
Objective:
To describe challenges in inpatient pediatric quality and safety during the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
In a previous qualitative study, our team sought to broadly describe changes in pediatric inpatient care during the pandemic. For both that study and this ancillary analysis, we purposefully sampled participants from community and children's hospitals in the 6 US states with the highest COVID-19 hospitalization rates from March to May 2020. We recruited 2 to 3 participants from each hospital (administrators, front-line physicians, nurses, caregivers) for semistructured interviews. We used constant comparative methods to identify themes regarding quality and safety challenges during the pandemic.
Results:
We interviewed 30 participants from 12 hospitals. Participants described several impacts to clinical workflows, including decreased direct clinician-patient interactions and challenges to communication, partly addressed through innovative use of telehealth technology. Participants reported changes in the discharge and transfer process (eg, discharges, difficulties accessing specialized facilities). Participants also described impacts to hospital operations, including changes in quality monitoring and operations (eg, decreased staff, data collection), increased health risks for clinicians and staff (eg, COVID-19 exposure, testing delays), and staff and supply shortages. Participants voiced concerns that negative quality and safety impacts could include increased risk of preventable safety events and hospital readmissions, and decreased patient engagement, education, and satisfaction.
Conclusions:
We identified several impacts to clinical workflows and hospital operations during the pandemic that may have affected inpatient pediatric care quality and safety. Our findings highlight potentially important areas of focus for planning pandemic recovery, preparing for future pandemics, and conducting future research on inpatient pediatric quality and safety.
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