The COVID-19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource-limited hospitals

• Type of Material: Article
• Authors: Parima P Wiphatphumiprates, Rhodes College; Dylan E Graetz, St. Jude Children's Research Hospital; Gia Ferrara, St. Jude Children's Research Hospital; Maria Puerto-Torres, St. Jude Children's Research Hospital; Srinithya R Gillipelli, Baylor College of Medicine; Paul Elish, Emory University; Hilmarie Muniz-Talavera, St. Jude Children's Research Hospital; Alejandra Gonzalez-Ruiz, St. Jude Children's Research Hospital; Miriam Armenta, Hospital General de Tijuana; Camila Barra, Hospital Dr. Luis Calvo Mackenna Hospital; Zulma Carpio, Instituto Nacional de Enfermedades Neoplasicas; Cinthia Hernandez, Hospital Infantil Teletón de Oncología; Susana Juarez, Hospital Central Dr. Ignacio Morines Prieto; Jose de Jesus Loeza, Centro Estatal de Cancerología; Alejandra Mendez, Unidad Nacional de Oncología Pediátrica; Erika Montalvo, Hospital Oncológico Solca Núcleo de Quito; Eulalia Penafiel, Instituto del Cáncer SOLCA Cuenca; Estuardo Pineda, Hospital Nacional de Niños Benjamín Bloom; Virgina McKay, Washington University in St. Louis; Asya Agulnik, St. Jude Children's Research Hospital
• Language: English
• Date: 2023-05-01
• Publisher: John Wiley & Sons Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/cam4.5876
• Title of Journal or Parent Work: Cancer Medicine
• Volume: 12
• Issue: 10
• Start Page: 11878
• End Page: 11888
• Grant/Funding Information: This study was funded by the American Lebanese‐Syrian Associated with Charities (ALSAC). Dr. Agulnik was funded by the Conquer Cancer Foundation Global Oncology Young Investigator Award for this work. These funders were not involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
• Keywords: Latin America; pediatric early warning system; quality improvement collaborative; pediatric oncology; COVID-19; Pandemics; Hospitals; PEWS; implementation science; resource-limited; Child; Delivery of Health Care; Humans; Neoplasms
• Research Categories: Health Sciences, Public Health

Abstract

Background: The COVID-19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource-limited settings. This study evaluates its impact on existing quality improvement (QI) programs. Methods: We conducted 71 semi-structured interviews of key stakeholders at five resource-limited pediatric oncology centers participating in a collaborative to implement Pediatric Early Warning System (PEWS). Interviews were conducted virtually using a structured interview guide, recorded, transcribed, and translated into English. Two coders developed a codebook of a priori and inductive codes and independently coded all transcripts, achieving a kappa of 0.8–0.9. Thematic analysis explored the impact of the pandemic on PEWS. Results: All hospitals reported limitations in material resources, reduction in staffing, and impacts on patient care due to the pandemic. However, the impact on PEWS varied across centers. Identified factors that promoted or limited ongoing PEWS use included the availability of material resources needed for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to prioritize PEWS. Consequently, some hospitals were able to sustain PEWS; others halted or reduced PEWS use to prioritize other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units. Several participants were hopeful for future expansion of PEWS post-pandemic. Conclusion: The COVID-19 pandemic created challenges for sustainability and scale of PEWS, an ongoing QI program, in these resource-limited pediatric oncology centers. Several factors mitigated these challenges and promoted ongoing PEWS use. These results can guide strategies to sustain effective QI interventions during future health crises.