@article{ref1,
title="National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic",
journal="World journal of critical care medicine",
year="2020",
author="Abulebda, Kamal and Ahmed, Rami A. and Auerbach, Marc A. and Bona, Anna M. and Falvo, Lauren E. and Hughes, Patrick G. and Gross, Isabel T. and Sarmiento, Elisa J. and Barach, Paul R.",
volume="9",
number="5",
pages="74-87",
abstract="BACKGROUND: The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine  and plan for the optimal allocation of medical resources for the highest priority  patients. There is limited data describing pediatric intensive care unit (PICU)  preparedness and their health worker protections. <br><br>AIM: To describe the current  coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within  a simulation-based network nationwide. <br><br>METHODS: A cross-sectional multi-center  national survey of PICU medical director(s) from children's hospitals across the  United States. The questionnaire was developed and reviewed by physicians with  expertise in pediatric critical care, disaster readiness, human factors, and survey  development. Thirty-five children's hospitals were identified for recruitment  through a long-established national research network. The questions focused on six  themes: (1) PICU and medical director demographics; (2) Pediatric patient flow  during the pandemic; (3) Changes to the staffing models related to the pandemic; (4)  Use of personal protective equipment (PPE); (5) Changes in clinical practice and  innovations; and (6) Current modalities of training including simulation. <br><br>RESULTS:  We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were  located within children's hospitals (87%). All PICUs cared for pediatric patients  with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed  decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6%  pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their  staffing models with the most common changes being changes in COVID-19 patient room  assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36%  of the PICU units. Ninety-five percent of PICUs conducted training for donning and  doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across  the United States reported shortages in PPE. The most common training formats for  PPE were hands-on training (73%) and video-based content (82%). The most common  concerns related to COVID-19 practice were changes in clinical protocols and  guidelines (50%). The majority of PICUs implemented significant changes in their  airway management (82%) and cardiac arrest management protocols in COVID-19 patients  (68%). Simulation-based training was the most commonly utilized training modality  (82%), whereas team training (73%) and team dynamics (77%) were the most common  training objectives. <br><br>CONCLUSIONS: A substantial proportion of surveyed PICUs  reported on large changes in their preparedness and training efforts before and  during the pandemic. PICUs implemented broad strategies including modifications to  staffing, PPE usage, workflow, and clinical practice, while using simulation as the  preferred training modality. Further research is needed to advance the level of  preparedness, support staff assuredness, and support deep learning about which  preparedness actions were effective and what lessons are needed to improve PICU care  and staff protection for the next COVID-19 patient waves.<p /> <p>Language: en</p>",
language="en",
issn="2220-3141",
doi="10.5492/wjccm.v9.i5.74",
url="http://dx.doi.org/10.5492/wjccm.v9.i5.74"
}