Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2022 Oct 18;23(6):893-896. doi: 10.5811/westjem.2022.7.57340.
The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PED) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models.
We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based questionnaire. The survey was sent via three national pediatric emergency medicine distribution lists, with several follow-up reminders.
There were 46 questionnaires included, completed by PED directors from 25 states. Forty-two sites provided PED volume and admission data for the early pandemic (March-July 2020) and a pre-pandemic comparison period (March-July 2019). Mean PED volume decreased >32% for each studied month, with a maximum mean reduction of 63.6% (April 2020). Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020. During the study period, 33 (71.1%) sites had decreased clinician staffing at some point. Only three sites (6.7%) reported decreased faculty protected time. All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between the PED and other units, and added tele-visit shifts. Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (interquartile ratio 25-28). Of 44 sites hosting medical trainees, 37 (84.1%) reported a decrease in number of trainees or elimination altogether. Thirty (68.2%) sites had restrictions on patient care provision by trainees: 28 (63.6%) affected medical students, 12 (27.3%) affected residents, and two (4.5%) impacted fellows. Fifteen sites (34.1%) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%).
This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models. During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellows' experience largely preserved. Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.
本研究旨在量化 2019 年冠状病毒病（COVID-19）大流行对美国（US）儿科急诊部（PED）的影响，特别是对住院医师临床教育以及患者数量、入院率和人员配备模式的影响。
我们对美国 PED 进行了横断面研究，通过网络问卷对 PED 临床负责人进行了调查。该调查通过三个全国儿科急诊医学分发列表发送，并进行了多次后续提醒。
共有 46 份问卷，由来自 25 个州的 PED 主任填写。42 个地点提供了大流行早期（2020 年 3 月至 7 月）和大流行前比较期（2019 年 3 月至 7 月）的 PED 量和入院数据。每个研究月份 PED 量下降超过 32%，最大平均降幅为 63.6%（2020 年 4 月）。2020 年 4 月，儿科入院率的平均百分比也达到峰值，为 38.5%，到 2020 年 7 月仍比基线高出 16.4%。在此期间，33 个（71.1%）地点在某个时候减少了临床医生的人员配备。只有三个地点（6.7%）报告说减少了教师的保护时间。所有 PED 都报告了人员配备的变化，包括减少中级人员的使用、增加随叫随到的工作人员、人员在 PED 和其他单位之间的流动以及增加远程访问班次。26 个地点（56.5%）提高了患者年龄上限；中位数为 25 岁（四分位距 25-28）。在 44 个接待医疗培训生的地点中，37 个（84.1%）报告培训生人数减少或完全取消。30 个（68.2%）地点限制了培训生提供的患者护理：28 个（63.6%）影响医学生，12 个（27.3%）影响住院医师，2 个（4.5%）影响研究员。15 个地点（34.1%）限制医学生（29.5%）、住院医师（20.5%）或研究员（4.5%）进行的操作。
本研究强调了 COVID-19 大流行对美国 PED 的显著影响，指出患者数量减少、入院率增加和人员配备模式改变。在大流行早期，PED 环境中对住院医师的教育限制对医学生的影响不成比例地超过了住院医师，研究员的经验基本保持不变。我们的研究结果量化了在此期间对住院医师儿科临床实习的影响程度。
