Examples of the Impact of the COVID-19 Pandemic in a Pediatric Hospital Categorized by the 6 Domains of Health Care Quality4
| Domain of Care . | Mechanism of Impact . | Example . |
|---|---|---|
| Safea | Limitations of virtual care (n = 6) | During follow-up after a recent neurosurgical intervention, the physical examination findings of skin infection and associated collection are not appreciated during a virtual appointment |
| — | Difficulty establishing a therapeutic relationship when providing care to a child with mental health issues, including selective mutism, social anxiety disorder, and learning disability | |
| Effectiveb | Restrictions to care (n = 2) | Mothers of out-born newborns are unable to transport expressed breast milk to NICU because they are not allowed visitors after delivery |
| Homecare for children with medical technology (n = 1) | Additional planning required to support the discharge of child with medical complexity and multiple technology dependencies (ventilator-dependent, tracheostomy, enterostomy feeds) with parental hesitancy in having home care nurses in the home | |
| Patient-centeredc | Change in visitor policy impacting child or youth (n = 4) caregivers or family (n = 4) | Siblings not as present during end-of-life care as previous, eg, sibling visited on 1 occasion during 28-d hospital stay |
| — | Disclosure of important information, including new diagnoses to 1 parent, the other joining by telephone | |
| Screening for COVID-19 impacting child experience (n = 3) | Multiple SARS-CoV-2 swabs required during a hospital stay to facilitate procedures and investigate new instances of fever, eg, 4 swabs required during a month in a child receiving chemotherapy causing distress | |
| Timelyd | Postponement of elective procedures (n = 12) | The risk of infection associated with the delayed removal of a Portacath that is no longer required. |
| Delayed acute presentation (n = 15) | A child presented with a 5-wk history of dyspnea, presyncope, and progressive dysphagia and a large mediastinal mass was identified on their presentation | |
| Deferral of care or follow-up (n = 12) | Parental deferral of routine follow-up with delayed identification of complications after corneal transplant | |
| Efficiente | Screening for COVID-19 impacting hospital flow (n = 5) | Admission required to complete investigations, eg, imaging, delayed as awaiting SARS-CoV-2 swab result |
| Equitablef | Reduced child care availability (n = 2) | Commencement of treatment eg, chemotherapy deferred on account of disruption of child care and school for other siblings |
| Closure of supports for family, eg, overnight accommodation (n = 2) | Increased costs associated with admission (eg, $135 a night for a hotel room for second caregiver because only 1 caregiver is permitted at bedside and usual supports are closed) |
| Domain of Care . | Mechanism of Impact . | Example . |
|---|---|---|
| Safea | Limitations of virtual care (n = 6) | During follow-up after a recent neurosurgical intervention, the physical examination findings of skin infection and associated collection are not appreciated during a virtual appointment |
| — | Difficulty establishing a therapeutic relationship when providing care to a child with mental health issues, including selective mutism, social anxiety disorder, and learning disability | |
| Effectiveb | Restrictions to care (n = 2) | Mothers of out-born newborns are unable to transport expressed breast milk to NICU because they are not allowed visitors after delivery |
| Homecare for children with medical technology (n = 1) | Additional planning required to support the discharge of child with medical complexity and multiple technology dependencies (ventilator-dependent, tracheostomy, enterostomy feeds) with parental hesitancy in having home care nurses in the home | |
| Patient-centeredc | Change in visitor policy impacting child or youth (n = 4) caregivers or family (n = 4) | Siblings not as present during end-of-life care as previous, eg, sibling visited on 1 occasion during 28-d hospital stay |
| — | Disclosure of important information, including new diagnoses to 1 parent, the other joining by telephone | |
| Screening for COVID-19 impacting child experience (n = 3) | Multiple SARS-CoV-2 swabs required during a hospital stay to facilitate procedures and investigate new instances of fever, eg, 4 swabs required during a month in a child receiving chemotherapy causing distress | |
| Timelyd | Postponement of elective procedures (n = 12) | The risk of infection associated with the delayed removal of a Portacath that is no longer required. |
| Delayed acute presentation (n = 15) | A child presented with a 5-wk history of dyspnea, presyncope, and progressive dysphagia and a large mediastinal mass was identified on their presentation | |
| Deferral of care or follow-up (n = 12) | Parental deferral of routine follow-up with delayed identification of complications after corneal transplant | |
| Efficiente | Screening for COVID-19 impacting hospital flow (n = 5) | Admission required to complete investigations, eg, imaging, delayed as awaiting SARS-CoV-2 swab result |
| Equitablef | Reduced child care availability (n = 2) | Commencement of treatment eg, chemotherapy deferred on account of disruption of child care and school for other siblings |
| Closure of supports for family, eg, overnight accommodation (n = 2) | Increased costs associated with admission (eg, $135 a night for a hotel room for second caregiver because only 1 caregiver is permitted at bedside and usual supports are closed) |
Avoiding harm to patients from care intended to help.
Provision of evidence-based care.
Incorporates a patient’s preferences, needs, and values into their care.
Avoidance of harmful delays for patients and health care providers.
Avoidance of waste.
Care does not vary in quality because of personal characteristics, eg, ethnicity, geographic location, socioeconomic status.