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Craddock KES, Grilo S, McCann TA, Catallozzi M, Banker SL. Physician Perspectives on the Impact of the COVID-19 Pandemic on Family-Centered Rounds. Hosp Pediatr 2021; 11:hpeds.2021-006004. [PMID: 34808670 DOI: 10.1542/hpeds.2021-006004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has required modifications to family-centered rounds (FCR), although the specific changes and the effects on patients, families, and providers are not well known. In this study, we explore physician perspectives on changes made to FCR during the initial wave of the coronavirus disease 2019 pandemic and recommendations for the future. METHODS Semistructured individual interviews were conducted with 20 pediatric attending and resident physicians who cared for hospitalized patients between March and May 2020 on pediatric hospital medicine and subspecialty services that typically perform FCR. Transcripts were reviewed by using principles of framework analysis to iteratively develop a codebook. Review of coded segments, with attention to code co-occurrences, was used to clarify themes in the data relating to the research objective and the conceptual framework. RESULTS The rounding format changed for all providers and varied on the basis of clinical service and phase of the pandemic. Themes highlighted specific areas of change: (1) the process of FCR, (2) reaching consensus with families, (3) collaboration with members of the medical team, and (4) resident education, modeling, and supervision. Participants offered recommendations, including standardization of rounds, intentional involvement of nursing staff, and inclusion of families through virtual or small-group bedside rounds. CONCLUSIONS The pandemic led to a variety of modifications to FCR, and these changes had varied effects on communication and education. These findings provide insight into the state of FCR during the pandemic and may frame future recommendations for the development of shared guidelines for circumstances requiring limited bedside rounding.
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Affiliation(s)
| | - Stephanie Grilo
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York
| | - Teresa A McCann
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York
| | - Marina Catallozzi
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York
| | - Sumeet L Banker
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York
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Brahmbhatt K, Mournet AM, Malas N, DeSouza C, Greenblatt J, Afzal KI, Giles LL, Charoensook J, Feuer V, Raza H, Mooneyham GC, Pergjika A, Schlesinger A, Chapman A, Strain A, Gandhi B, Johnson K, Mroczkowski MM, Ibeziako P, Graham R, Yoon Y, Plioplys S, Fuchs C, Shaw RJ, Pao M. Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey. J Acad Consult Liaison Psychiatry 2021; 62:511-521. [PMID: 34033972 PMCID: PMC8141785 DOI: 10.1016/j.jaclp.2021.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.
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Affiliation(s)
- Khyati Brahmbhatt
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA.
| | - Annabelle M Mournet
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | - Nasuh Malas
- University of Michigan Medical School, Department of Psychiatry and Department of Pediatrics, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Claire DeSouza
- University of Toronto, Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Jeanne Greenblatt
- NYU Grossman School of Medicine, Departments of Child Psychiatry and Pediatrics, NYU Hassenfeld Children's Hospital and Bellevue Hospital Center, New York, NY
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Lisa L Giles
- University of Utah School of Medicine, Departments of Pediatrics and Psychiatry, Primary Children's Hospital, Salt Lake City, UT 84113
| | - Janet Charoensook
- Children's Hospital Los Angeles, Division of Psychiatry, Los Angeles, CA
| | - Vera Feuer
- Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | - Haniya Raza
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | | | - Alba Pergjika
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Amanda Schlesinger
- University of Minnesota Medical School. F262 West Building, Minneapolis, MN
| | - Andrea Chapman
- University of British Columbia, Department of Psychiatry, British Columbia Children's Hospital, Vancouver, BC
| | - Angela Strain
- The University of North Carolina at Chapel Hill, Department of Emergency Medicine, Chapel Hill, NC
| | - Bela Gandhi
- Nationwide Children's Hospital, Department of Psychiatry. 444 Butterfly Gardens Drive, Columbus, OH
| | - Kyle Johnson
- Oregon Health & Science University. Division of Child & Adolescent Psychiatry, Portland, OR
| | - Megan M Mroczkowski
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston MA
| | - Regina Graham
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA
| | - Yesie Yoon
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL
| | - Sigita Plioplys
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Catherine Fuchs
- Vanderbilt University, Department of Psychiatry and Behavioral Sciences and Pediatrics, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Richard J Shaw
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences. 401 Quarry Road, Palo Alto, CA
| | - Maryland Pao
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
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