Secondary impacts of the COVID-19 pandemic at a tertiary children's hospital in Canada: a mixed-methods study.

Autor:	Diskin C; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada catherine.diskin@sickkids.ca.; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada., Orkin J; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada., Dharmaraj B; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada., Agarwal T; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada., Parmar A; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada., McNaughton K; Peer Support Program, The Hospital for Sick Children, Toronto, Ontario, Canada., Cohen E; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada., Sunderji A; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.; Division of Emergency Medicine, The Hospital for Sick Kids, Toronto, Ontario, Canada., Faraoni D; Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada., Fecteau A; Division of General and Thoracic Surgery, The Hospital for Sick Children-SickKids, Toronto, Ontario, Canada., Fischer J; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.; Division of Emergency Medicine, The Hospital for Sick Kids, Toronto, Ontario, Canada., Maynes J; Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada., Mahant S; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada., Friedman J; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Apr 13; Vol. 13 (4), pp. e059849. Date of Electronic Publication: 2023 Apr 13.
DOI:	10.1136/bmjopen-2021-059849
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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