Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2023 Apr 13;13(4):e059849. doi: 10.1136/bmjopen-2021-059849.
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.
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.
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.
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.
在 COVID-19 大流行的初始阶段，决定暂停所有非必要的儿科医院活动，这可能导致医疗保健的显著延迟、推迟和中断。本研究探讨了由于 COVID-19 大流行导致的限制而导致医疗服务提供方式发生变化，从而导致儿童护理受到负面影响的临床案例。
本研究采用混合方法，包括：（1）对 2020 年 5 月至 8 月期间的整体描述性医院活动进行定量分析，并对研究期间的数据进行利用；（2）采用定性多案例研究设计，对临床医生报告的 COVID-19 大流行对三级儿童医院提供的护理的影响进行描述性主题分析。
医院层面的利用和活动模式显示医院活动发生了重大变化，包括急诊科就诊人数最初减少 38%，以及 COVID-19 之前门诊虚拟护理占比 4%，而 2020 年 5 月至 8 月期间增加到 67%。212 名临床医生报告了总共 116 个独特案例。出现了包括（1）护理及时性、（2）患者为中心的护理中断、（3）提供安全有效的护理的新压力以及（4）COVID-19 大流行体验的不平等在内的主题，每个主题都对患者、他们的家人和医疗保健提供者产生影响。
意识到 COVID-19 大流行在所有确定的主题中影响的广度对于确保及时、安全、高质量、以家庭为中心的儿科护理的提供非常重要。
