Over the course of two weeks in March 2020, COVID-19 cases at Montefiore grew from two to almost 700.
As the health care system looked to increase capacity, an inpatient pediatric unit at the Children’s Hospital at Montefiore (CHAM) quickly became a 40-bed unit that would be home to adult patients. A new, first-of-its-kind report published in the Journal of Pediatrics describes the rapid transformation that took place.
The report also shared valuable lessons learned and best practices for healthcare providers throughout the country, who may face a similar situation in the weeks ahead.
“In collaboration with our adult care providers, we quickly trained CHAM clinicians on how to provide an effective, informed and thoughtful approach to care for our new adult patients,” said lead author Kaitlyn Philips, DO, assistant medical director of Pediatric Quality, CHAM and assistant professor of pediatrics at Albert Einstein College of Medicine. “In a matter of weeks, our physicians and nurses became accustomed to new policies and protocols, caring for adults with a highly contagious disease, and many with other underlying conditions.”
Instead of assigning pediatricians to be part of teams led by adult medicine physicians, Montefiore developed a strategy of training pediatrician-led teams and having them work within their own familiar setting. Established CHAM teams of pediatric physicians and nurses consulted with adult-medicine physicians to provide life-saving care to more than 100 patients within 10 days of accepting adults.
The new report outlines the steps taken to prepare and train pediatric healthcare providers on how to treat a new, older population, including enhanced communication, adapted rounding practices and a new approach with adult hospital medicine providers.
“This effort is a true example of interdisciplinary care and all-hands-on-deck preparation,” said Michael Cabana, physician-in-chief at CHAM and The Michael I. Cohen, University Chair in the Department of Pediatrics at Albert Einstein College of Medicine. “Our teams mobilized early, quickly and effectively to provide high-quality care to the parents and grandparents of their usual patients. Being part of a large, integrated healthcare system enabled us to access the expertise and resources necessary to provide this care.”
In addition to providing recommended therapies for adults, the team recognized that palliative care is crucial. Dr. Cabana and Dr. Sarah Norris, director of Pediatric Palliative Care and the Quality in Life Team (QUILT) at CHAM, trained 27 pediatricians, nurse practitioners and psychologists in one week.
They were then deployed throughout the adult COVID-19 unit at CHAM to help patients and their families stay connected, informed and educated during hospitalization. The expanded QUILT team became a lifeline for patients and their families, available seven days per week to help them as they faced complex medical decisions and uncertainty.
The last adult patient has been discharged from CHAM and the providers will now care for pediatric patients again. Approximately 150 adults received COVID-19 treatment at CHAM.