Disruptions in Care: Consequences of the COVID-19 Pandemic in a Children’s Hospital

Abstract

Background

Public health restrictions are an essential strategy to prevent the spread of COVID-19; however, unintended consequences of these interventions may have led to significant delays, deferrals and disruptions in medical care. This study explores clinical cases where the care of children was perceived to have been negatively impacted as a result of public health measures and changes in healthcare delivery and access due to the COVID-19 pandemic.

Methods

This study used a qualitative multiple case study design with descriptive thematic analysis of clinician-reported consequences of the COVID-19 pandemic on care provided at a children’s hospital. A quantitative analysis of overall hospital activity data during the study period was performed.

Results

The COVID-19 pandemic has resulted in significant change to hospital activity at our tertiary care hospital, including an initial reduction in Emergency Department attendance by 38% and an increase in ambulatory virtual care from 4% before COVID-19, to 67% in August, 2020. Two hundred and twelve clinicians reported a total of 116 unique cases. Themes including (1) timeliness of care, (2) disruption of patient-centered 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 pediatric care moving forward.

What’s new

COVID-19 disrupted typical paediatric care delivery.

This study demonstrates the breadth of its’ impact on the delivery of timely, safe, equitable and patient and family centered care, highlighting considerations for paediatric providers as we move forward.

SciScore for 10.1101/2021.12.02.21266778: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	IRB: The study protocol was reviewed and approved by the Hospital for Sick Children’s Research Ethics Board (#1000070386).
Sex as a biological variable	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Cell Line Authentication	not detected.

Table 2: Resources

Experimental Models: Cell Lines
Sentences	Resources
Three independent research team members (TA, CD and JO) undertook the thematic analysis.	TA suggested: RRID:CVCL_4315)
Software and Algorithms
Sentences	Resources
(REDCap) platform.	REDCap suggested: (REDCap, RRID:SCR_003445)

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when …

SciScore for 10.1101/2021.12.02.21266778: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	IRB: The study protocol was reviewed and approved by the Hospital for Sick Children’s Research Ethics Board (#1000070386).
Sex as a biological variable	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Cell Line Authentication	not detected.

Table 2: Resources

Experimental Models: Cell Lines
Sentences	Resources
Three independent research team members (TA, CD and JO) undertook the thematic analysis.	TA suggested: RRID:CVCL_4315)
Software and Algorithms
Sentences	Resources
(REDCap) platform.	REDCap suggested: (REDCap, RRID:SCR_003445)

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

Limitations: This study was performed in a single tertiary-care pediatric academic centre, limiting its generalizability. We recognize that the approach taken by hospitals to the COVID-19 pandemic may vary.36 The case finding methodology used was not real-time and cannot provide a denominator or frequency for events. However, a thorough review of M&M records uncovered only 1 additional case, suggesting that the frequency of survey distribution and its prospective nature might mitigate this limitation. The study is clinician-centric, but involved only doctors and advanced practice nurses. A broader representation of health care providers including bedside nurses and allied health professionals would result in a richer understanding of the disruption in care related to the COVID-19 pandemic. The involvement of patients and family caregivers is required to enhance our understanding37, as the challenges faced by patients due to delays might be overlooked. More subtle manifestations of inequity may have been overlooked as the study did not examine the various contributing factors to the individual experience of the pandemic. Lastly, the results reflect the experience of frontline clinicians who chose to respond and are therefore subject to their bias. To truly understand the parent and child perspective, we plan to further engage with families and describe their experiences as a future step in this work.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

Results from scite Reference Check: We found no unreliable references.

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