by Shivani Goswami
MHA, Senior Pediatric Program Manager

As cases of COVID-19 continue to soar across the country, and with adults having a much higher risk than children of serious illness that requires ICU care, pediatric hospitals face the prospect of being amenable to sharing their critical ICU resources for adult patients who are in need during the pandemic. This comes at a time when children’s hospitals are also working to stabilize their supply chains, manage supply costs and drive operational efficiency while continuing to deliver value and care for their young patients. 

Given the dynamics of the current health care landscape, here are six things pediatric hospitals should be doing to prepare for adult patients while balancing their primary commitment to serve the children who may still need dedicated resources that only a children’s hospital can provide:

  1. Create a command center that includes all key stakeholders for strategic decisions on protocols to plan for needed adjustments to facilities, mitigate risks, direct communications for all staff and implement necessary workforce restructuring.
  2. Integrate monitoring dashboards with EHR to track patient admission, bed management, average daily census of personal protective equipment allocation and other metrics to track pandemic-related data and KPIs.
  3. Coordinate triage protocols between children and adults. Develop screening criteria and clear guidelines for patient assignment on arrival — how to select adult patients for admission or for transportation to an adult hospital.
  4. Educate and train clinicians and nurses to understand anticipated COVID-19 complications and learn the protocols for an adult care model. Methods include “train-the-trainer” initially provided by adult-care providers and proactively simulating common COVID-related scenarios, such as intubating and providing oxygen therapy to adult patients.
  5. Plan for adjusting and reallocating scarce and critical equipment, supplies, and medications to run a functional adult medical unit with correct dosages and sizes for taller and heavier patients. For example, stock commonly prescribed medications for adults at larger quantities and carry 20 cm central venous catheters primarily used on adults instead of capping at 15 cm, which are primarily used on pediatric patients.
  6. Expand telehealth solution to include adult clinician support so that pediatrics-trained providers can care for complex adult patients.

With significant resource allocation limitations, the COVID-19 pandemic is likely to push pediatric hospitals to expand their scope of care and navigate the unique challenges of adult patient care. Now is the time to begin to determine the strategy, logistics, clinical resources and expanded supply requirements that will be necessary if your pediatric facility must begin caring for adult patients. The steps outlined above are a starting point and Vizient, and its Pediatric Program, offers its members education on emerging evidence-based practices to transform clinical care as they evolve during this pandemic. For more information, visit our COVID-19 Resources page.

About the author. As senior pediatric program manager, Shivani Goswami leads Vizient’s strategic pediatric program, managing a clinically, financially, and pediatric-focused portfolio. She is a co-facilitator for the Pediatric Council, which discusses current challenges and trends in pediatric supply chain and co-founder of Health Connect South, a nonprofit platform for regional health collaborations.