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Secondary impacts of the COVID-19 pandemic at a tertiary children's hospital in Canada: a mixed-methods study
Catherine Diskin1,2, Julia Orkin2,3, Blossom Dharmaraj4
1Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada catherine.diskin@sickkids.ca.
Insights
Paediatric care faced significant disruptions during the COVID-19 pandemic due to paused activities. Clinicians reported negative impacts on care timeliness, patient-centeredness, safety, and equity.
Area of Science:
- Pediatric healthcare
- Public health
- Pandemic response
Background:
- The COVID-19 pandemic necessitated pausing non-essential pediatric hospital activities.
- These changes may have caused significant delays and disruptions in children's medical care.
Purpose of the Study:
- To explore clinical cases where pediatric care was negatively impacted by COVID-19 related healthcare delivery changes.
- To understand clinician-perceived consequences of pandemic restrictions on children's healthcare.
Main Methods:
- A mixed-methods approach was employed, combining quantitative analysis of hospital activity data (May-August 2020) and a qualitative multiple-case study.
- Descriptive thematic analysis was used for clinician-reported consequences.
Main Results:
- Hospital activity saw a 38% reduction in emergency department attendance and a shift to 67% virtual care.
- 212 clinicians reported 116 unique cases, revealing themes of compromised care timeliness, disrupted patient-centered care, new safety/efficiency pressures, and inequity.
Conclusions:
- Awareness of the pandemic's broad impact on pediatric care is crucial.
- This understanding is vital for ensuring timely, safe, high-quality, and family-centered pediatric care in the future.
Objectives:
Decisions to pause all non-essential paediatric hospital activities during the initial phase of the COVID-19 pandemic may have led to significant delays, deferrals and disruptions in medical care. This study explores clinical cases where the care of children was perceived by hospital clinicians to have been negatively impacted because of the changes in healthcare delivery attributing to the restrictions placed resulting from the COVID-19 pandemic.
Design And Setting:
This study used a mixed-methods approach using the following: (1) a quantitative analysis of overall descriptive hospital activity between May and August 2020, and utilisation of data during the study period was performed, and (2) a qualitative multiple-case study design with descriptive thematic analysis of clinician-reported consequences of the COVID-19 pandemic on care provided at a tertiary children's hospital.
Results:
Hospital-level utilisation and activity patterns revealed a substantial change to hospital activity including an initial reduction in emergency department attendance by 38% and an increase in ambulatory virtual care from 4% before COVID-19 to 67% between May and August 2020. Two hundred and twelve clinicians reported a total of 116 unique cases. Themes including (1) timeliness of care, (2) disruption of patient-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic emerged, each impacting patients, their families and healthcare providers.
Conclusion:
Being aware of the breadth of the impact of the COVID-19 pandemic across all of the identified themes is important to enable the delivery of timely, safe, high-quality, family-centred paediatric care moving forward.
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