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TABLE 2

Examples of the Impact of the COVID-19 Pandemic in a Pediatric Hospital Categorized by the 6 Domains of Health Care Quality

Domain of CareMechanism of ImpactExample
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 CareMechanism of ImpactExample
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) 
a

Avoiding harm to patients from care intended to help.

b

Provision of evidence-based care.

c

Incorporates a patient’s preferences, needs, and values into their care.

d

Avoidance of harmful delays for patients and health care providers.

e

Avoidance of waste.

f

Care does not vary in quality because of personal characteristics, eg, ethnicity, geographic location, socioeconomic status.

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