Background The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children’s and community hospitals. Methods We purposefully sampled participants from both community and children’s hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2–3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes. Results We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians’ mental health, and they stressed the importance of mental health resources and wellness activities/spaces. Conclusions We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians’ expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians’ mental health and well-being, re-evaluating trainees’ skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.

Introduction Coaching is a growing clinician-educator role. Self-efficacy is a powerful faculty motivator that is associated positively with job satisfaction and negatively with burnout. This study examines self-efficacy, job satisfaction, and burnout in coaches and other clinician-educators. Methods We conducted a mixed methods study using a quantitative survey followed by qualitative interviews of faculty at the University of California, San Francisco. Coaches (funded 20% full-time equivalents), faculty with other funded education positions (“funded”), and faculty without funded education positions (“unfunded”) completed a 48-item survey addressing self-efficacy (teaching, professional development, and scholarship), job satisfaction, and burnout. Data were analyzed using analysis of variance followed by post-hoc tests and chi-square tests. To elaborate quantitative results, we conducted qualitative interviews of 15 faculty and analyzed data using framework analysis. Results 202 of 384 faculty (52.6%) responded to the survey; 187 complete surveys were analyzed. Teaching self-efficacy was similar across groups. Coaches and funded educators had significantly higher professional development self-efficacy and job satisfaction than unfunded educators. Burnout was more prevalent in coaches and unfunded educators. Qualitative analysis yielded three themes: sources of reward, academic identity, and strategies to mitigate burnout. Educator roles provide reward that enhances self-efficacy and job satisfaction but also generate competing demands. Coaches cited challenges in forming professional identities and working with struggling learners. Discussion The coaching role provides faculty with benefits similar to other funded educator roles, but the particular demands of the coach role may contribute to burnout.

Research Objective The COVID‐19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. This study aims to identify major changes in inpatient pediatric healthcare delivery and potential lessons learned. Study Design In this study, we conducted semi‐structured video interviews. We analyzed interview data using constant comparative methods to identify major healthcare delivery changes for hospitalized children during the COVID‐19 pandemic. Population Studied We purposefully sampled clinicians from both community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 participants from each hospital to interview (mix of administrators, physicians, and nurses). Principal Findings We interviewed 24 participants from 12 hospitals and identified several themes [Table 1]. They described how hospital leaders rapidly developed policies to: 1) ensure adequate staff for surges of COVID‐19 patients, 2) provide adequate care spaces and supplies, 3) direct use of personal protective equipment, and 4) guide medical management of COVID‐19 patients. Hospital leaders optimized communication by conducting regular meetings to discuss the current state of the pandemic, hospital operations, and policy changes. In the setting of declining volumes of hospitalized children, clinicians newly provided care for hospitalized adults . This was facilitated by developing care teams supported by adult hospitalists, educational resources, and telehealth supports. Participants described negative impacts of the pandemic on clinicians' mental health, as well as helpful supports for clinician well‐being, including mental health resources, wellness activities and spaces, and housing. Finally, participants described experiences managing multisystem inflammatory syndrome in children including diagnostic uncertainty and evolving management for this novel disease. Changes in Pediatric Hospital Care during the COVID‐19 Pandemic: A National Qualitative Study Theme Exemplary Quote Developing and evolving COVID‐related hospital policies“We have eight separate COVID related pathways. One for outpatient, one for ED, one for inpatient, and one for therapeutics. Pretty rigorous.”Successful communication with clinicians and staff“One of the things that went really well was… daily town halls and transparency for the rapidly evolving situation.”Newly providing care for hospitalized adults“They had what they called a super hospitalist, who was an adult hospitalist who would oversee…five or six different [mixed specialty care] teams and help out with some of the decision making.”Organizing spaces for COVID‐19 patient care“As [the only freestanding] children's hospital [in the city], our role ended up being kind of a referral center for all the other centers to offload their pediatric patients.” Conclusions We identified several changes in in...

OBJECTIVE: To describe challenges in inpatient pediatric quality and safety during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In a previous qualitative study, our team sought to broadly describe changes in pediatric inpatient care during the pandemic. For both that study and this ancillary analysis, we purposefully sampled participants from community and children’s hospitals in the 6 US states with the highest COVID-19 hospitalization rates from March to May 2020. We recruited 2 to 3 participants from each hospital (administrators, front-line physicians, nurses, caregivers) for semistructured interviews. We used constant comparative methods to identify themes regarding quality and safety challenges during the pandemic. RESULTS: We interviewed 30 participants from 12 hospitals. Participants described several impacts to clinical workflows, including decreased direct clinician-patient interactions and challenges to communication, partly addressed through innovative use of telehealth technology. Participants reported changes in the discharge and transfer process (eg, discharges, difficulties accessing specialized facilities). Participants also described impacts to hospital operations, including changes in quality monitoring and operations (eg, decreased staff, data collection), increased health risks for clinicians and staff (eg, COVID-19 exposure, testing delays), and staff and supply shortages. Participants voiced concerns that negative quality and safety impacts could include increased risk of preventable safety events and hospital readmissions, and decreased patient engagement, education, and satisfaction. CONCLUSIONS: We identified several impacts to clinical workflows and hospital operations during the pandemic that may have affected inpatient pediatric care quality and safety. Our findings highlight potentially important areas of focus for planning pandemic recovery, preparing for future pandemics, and conducting future research on inpatient pediatric quality and safety.

A case of natalizumab-associated progressive multifocal leukoencephalopathy in a 38-year-old woman is presented showing characteristics on magnetic resonance imaging (MRI) with high signal on T2-weighted images and patchy contrast enhancement. After 5 days of plasma exchange therapy, contrast enhancement decreased, but the abnormality on T2-weighted images increased. Perfusion MRI at this time demonstrated significantly increased blood flow to the lesion. Thirteen days after initiation of treatment, perfusion MR returned to normal in advance of significant anatomical changes on conventional MRIs. This case suggests that MR perfusion imaging may be helpful in monitoring the treatment of patients with natalizumab-associated progressive multifocal leukoencephalopathy.