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A Tale of 8 Cities: Pediatric Critical Care Redeployment to Adult Care During Wave 1 of COVID-19
Folafoluwa O Odetola1,2, Erin F Carlton1,2, Alyssa Dews2
1Department of Pediatrics, Division of Pediatric Critical Care Medicine.
Insights
Pediatric intensivists redeployed to care for adults during COVID-19 faced significant challenges but would do so again. This substantial redeployment highlights the need for better preparedness in public health emergencies.
Area of Science:
- Critical Care Medicine
- Public Health
- Pandemic Response
Background:
- During the COVID-19 pandemic, pediatric hospital resources were repurposed to care for adult patients.
- This included critical care faculty (pediatric intensivists) and pediatric intensive care unit (PICU) beds.
Purpose of the Study:
- To quantify the extent of pediatric hospital resource redeployment during the COVID-19 pandemic.
- To understand the experiences and challenges faced by pediatric intensivists providing critical care to adults with COVID-19.
Main Methods:
- A mixed-methods study was conducted across 9 hospitals in 8 U.S. cities.
- Quantitative data from surveys on resource redeployment and qualitative data from interviews with 40 pediatric intensivists were collected.
Main Results:
- Significant expansion of adult ICU beds occurred, with substantial proportions of faculty, nurses, respiratory therapists, ventilators, and PICU beds redeployed.
- Pediatric intensivists reported challenges including unfamiliar settings, lack of COVID-19 knowledge, fear of infection, limited supplies, and exhaustion.
Conclusions:
- Pediatric resource redeployment was extensive, demonstrating a significant impact on hospital capacity.
- Despite facing considerable challenges, pediatric intensivists expressed willingness to redeploy again, emphasizing the need for improved preparedness and interprofessional collaboration for future emergencies.
Background:
Pediatric hospital resources including critical care faculty (intensivists) redeployed to provide care to adults in adult ICUs or repurposed PICUs during wave 1 of the coronavirus disease 2019 (COVID-19) pandemic.
Objectives:
To determine the magnitude of pediatric hospital resource redeployment and the experience of pediatric intensivists who redeployed to provide critical care to adults with COVID-19.
Methods:
A mixed methods study was conducted at 9 hospitals in 8 United States cities where pediatric resources were redeployed to provide care to critically ill adults with COVID-19. A survey of redeployed pediatric hospital resources and semistructured interviews of 40 redeployed pediatric intensivists were simultaneously conducted. Quantitative data were summarized as median (interquartile range) values.
Results:
At study hospitals, there was expansion in adult ICU beds from a baseline median of 100 (86-107) to 205 (108-250). The median proportion (%) of redeployed faculty (88; 66-100), nurses (46; 10-100), respiratory therapists (48; 18-100), invasive ventilators (72; 0-100), and PICU beds (71; 0-100) was substantial. Though driven by a desire to help, faculty were challenged by unfamiliar ICU settings and culture, lack of knowledge of COVID-19 and fear of contracting it, limited supplies, exhaustion, and restricted family visitation. They recommended deliberate preparedness with interprofessional collaboration and cross-training, and establishment of a robust supply chain infrastructure for future public health emergencies and will redeploy again if asked.
Conclusions:
Pediatric resource redeployment was substantial and pediatric intensivists faced formidable challenges yet would readily redeploy again.
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