National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

Table 1 Hospital pediatric intensive care unit characteristics

Characteristics of the pediatric intensive care units	n = 22 (%)
Primary hospital setting description
Academic children’s hospital	14 (63.64)a
Community children’s hospital	5 (22.73)
Children’s hospital with a combined pediatric/adult hospital	2 (9.09)
Other	1 (4.55)
Number of children’s hospitals by bed capacity
Less than 100	4 (18.18)
100-199	4 (18.18)
200-299	5 (22.73)
300-399	5 (22.73)
400+	4 (18.18)
PICU description
Combined PICU/Cardiac ICU	6 (27.27)
PICU with a separate CICU at our institution	11 (50.00)
PICU only/ No CICU at our institution	5 (22.73)
Number of PICU beds per institution
< 16	6 (27.27)
16-30	10 (45.45)
31-45	4 (18.18)
> 45	2 (9.09)
Number of patients with confirmed COVID admitted to PICUs
1-3	13 (61.90)
4-6	1 (4.76)
7-9	4 (19.05)
> 10	3 (14.29)

^aP < 0.05.

COVID: Coronavirus disease; CICU: Cardiac intensive care unit; ICU: Intensive care unit; PICU: Pediatric intensive care unit.

Table 2 Preparedness efforts of pediatric intensive care units

Changes in patient flow across PICUs	n (%)
Changes in the average non-COVID patients seen during the COVID season
Increase in non-COVID patients
Decrease in non-COVID patients	19 (83.4)a
No change	2 (9.52)
Presence of COVID dedicated unit(s)?
Yes	9 (42.86)
No	12 (57.14)
Change in patients age range to include adult patients?
Yes	10 (74.62)
No	11 (52.38)
Changes in the staffing model
Implementation of changes to the healthcare provider staffing model
Change in length of shift	4 (18.8)
Change in providers assignment for COVID-19 patients, dedicated teams	5 (22.73)
Change in patient triaging model	7 (31.82)
Change in room assignment	11 (50.00)
Introducing remote patient monitoring in PICU	8 (36.63)
Other	5 (22.73)
Limiting the exposure of medical trainees for patients with known or suspected COVID-19
Fellows prohibited from direct patient contact
Fellows limited but not prohibited from direct patient care	7 (31.82)
APPs students prohibited from direct patient	10 (45.45)
APPs students limited but not prohibited from direct patient care	1 (4.55)
Residents prohibited from direct patient care	5 (22.73)
Residents limited but not prohibited from direct patient care	11 (50.00)
Medical students prohibited from direct patient care	20 (90.91)a
Medical students limited but not prohibited from direct patient care	1 (4.55)
No changes

^aP < 0.05.

APPs: Advanced practice providers; COVID: Coronavirus disease; PICU: Pediatric intensive care unit.

Table 3 Personal preparedness efforts by pediatric intensive care units

The use of PPEs	n (%)
Current issues/limitations in regards to the utilization of PPE
Lack of access to PPE
Shortage in PPE	7 (31.82)
Inability to reuse PPE	1 (4.55)
No issues	14 (63.64)
Conducting training to appropriately don and doff PPE for PICU staff
Yes	21 (95.45)a
No
Unsure
Format of PPE training
Hands-on training	16 (72.73)a
Video-based content	18 (81.82)a
Didactic/small group training	7 (31.82)
Email material	13 (59.09)
Other	2 (9.09)
Procedures to enhance safety of PPE
Buddy system	8 (36.36)
Increased staff	6 (27.27)
Dedicated staff, spotter	11 (50.00)
Distribution of printed safety	13 (59.09)
Other	1 (4.55)
None	2 (9.09)
Auditing PPE competencies
Assess the performance of doffing team	14 (63.64)
Written examination
Simulation assessment	7 (31.82)
Provide structured feedback around key competency areas	4 (18.18)
Regularly assess competencies with spot checks and/or video	6 (27.27)
None	1 (4.55)
Optimization of PPE doffing areas
Dedicated doffing area to avoid team members from bumping into one another or equipment	4 (18.18)
Zoning to distinguish clean area from potentially contaminated areas to reduce the likelihood that team members cross over between areas spreading contamination	8 (63.64)
Use the same space for donning and doffing of PPE	14 (63.64)
Dedicated staff to observe the doffing process, Doffing spotters	7 (31.82)
Other	5 (22.73)

^aP < 0.05.

PICU: Pediatric intensive care unit; PPE: Personal protective equipment.

Table 4 Preparedness efforts by pediatric intensive care units

Practice change/Innovations	n (%)
Concerns related to the current COVID-19 clinical practice
Lack of clinical guidelines/protocols	5 (22.73)
Changes in guidelines/protocols	11 (50.00)
Lack of PPE training	3 (13.64)
Physician staff shortage
RN staff shortage	2 (9.09)
Other staff shortage	1 (4.55)
Shortage in equipment/supplies	8 (36.36)
Patient surge and crowding	5 (22.73)
Other	5 (22.73)
Implementation of COVID focused airway management training
Yes	18 (81.82)
No	3 (13.64)
Unsure
Practice innovations for airway management
Caring for patients with suspected or confirmed COVID in negative pressure room	14 (63.64)
Using video laryngoscopy only for intubation	15 (68.18)
Decreased clinical care team numbers at bedside	19 (86.36)a
Incorporating new methods of communication between team members	16 (72.73)a
Implementing airway management checklists	15 (68.18)
Using telemedicine/video technology	9 (40.91)
Other	2 (9.09)
Intubation of suspected or confirmed COVID patients
By anesthesiologist who responds as part of the Airway Team	5 (22.73)
Anesthesiologist or other dedicated airway provider who is called if intubation is required	7 (31.82)
Attending physician unless the patient is suspected of having a difficult airway	12 (54.55)
Attending physician or fellow	7 (31.82)
Any appropriately trained member of the team
Other	8 (36.36)
Implementation of COVID focused cardiac arrest management training
Yes	15 (68.18)
No	6 (27.27)
Unsure
Practice innovations for cardiac arrest management
Caring for patients with suspected or confirmed COVID in negative pressure rooms only	13 (59.09)
Changing CPR practices	10 (45.45)
Decreased clinical care team numbers at bedside	16 (72.73)a
Incorporating new methods of communication between team members	15 (68.18)a
Using telemedicine/video technology	7 (31.82)
Other	4 (18.18)
Implementation of surge capacity management training
Yes	8 (36.36)
No	13 (59.09)
Unsure
How does your PICU keep all providers updated regarding COVID preparedness activities?
Mass e-mails	20 (90.91)a
Regular in-person huddle/meetings	11 (50.00)
Virtual conferences/meetings	17 (77.27)a
Simulation-based	9 (40.91)
Other

^aP < 0.05.

COVID: Coronavirus disease; CPR: Cardiopulmonary resuscitation; PPE: Personal protective equipment; PICU: Pediatric intensive care unit; RN: Registered nurse.

Table 5 Preparedness efforts by pediatric intensive care units

COVID-19 training modalities	n (%)
Modalities currently utilized for training staff?
Video/teleconference	17 (7.27)
Didactic	12 (54.55)
Online modules	10 (45.45)
Simulation-based training	18 (81.82)
Virtual reality	1 (4.55)
Other
Importance of simulation-based training for the preparation of PICU staff for COVID-19 patient management
Extremely important	9 (40.91)
Important	7 (31.82)
Neutral	1 (4.55)
Unimportant
Not at all important
Objectives of the simulation-based training
PPE, donning and doffing	12 (54.55)
Individual procedural skills, i.e. intubation	13 (59.09)
Team training, i.e. CPR	16 (72.73)
Team dynamics, i.e. communication	17 (77.27)
Mass casualty and surge capacity management	1 (4.55)
Diagnostic testing	1 (4.55)
Facility utilization and contingency planning, use of negative pressure rooms	2 (9.09)
Tent deployment	1 (4.55)
Other
Location of the training
Simulation center	3 (13.64)
In situ, in its original place or location	17 (77.27)
Classroom setting
Other format, boot camp	1 (4.55)
Simulation equipment
High-fidelity, full body mannequin, simulator	13 (59.09)
Low-fidelity, full body mannequin, simulator	7 (31.82)
Task trainers, intubation heads, central line trainers, etc.	7 (31.81)
Standardized patients, actors	1 (4.55)
Virtual Reality	3 (13.64)
Other
Participating members
Physicians	17 (77.27)
Nurses	17 (77.27)
Respiratory therapists	15 (68.18)
Technicians	5 (22.73)
Residents/fellows	15 (68.18)
Students
Other staff
What simulation training was the MOST helpful
PPE, donning and doffing	6 (27.27)
Individual procedural skills, i.e. intubation	8 (36.36)
Team training, i.e. CPR	12 (54.55)
Team dynamics, i.e. communication	10 (45.45)
Other	1 (4.55)
What simulation training was the LEAST helpful
PPE, donning and doffing	3 (13.64)
Individual procedural skills, i.e. intubation	2 (9.09)
Team training, i.e. CPR	2 (9.09)
Team dynamics, i.e. communication	2 (9.09)
Other	8 (36.36)
Facilitators of the simulation-based training
Presence of a simulation center	7 (31.82)
Presence of a simulation team in your department/hospital	15 (68.18)
Buy-in/support from hospital administration team	8 (36.36)
Involvement in other simulation collaborative and simulation leadership	7 (31.82)
Other	8 (36.36)
Challenges to execute simulation-based training
Buy-in/support from hospital administration team	1 (4.55)
Financial resources	7 (31.82)
Securing adequate supplies, PPE	7 (31.82)
Staff buy-in and participation	4 (18.18)
Lack of a trained simulation team
Lack of simulation logistics/supplies	4 (18.18)
Lack of time for preparation	5 (22.73)
Lack of desire for this form of training	1 (4.55)
Other	7 (31.82)
Development of novel or unique training equipment or training aides
Yes, i.e. intubating fume hood, please share	7 (31.82)
No	10 (45.45)

COVID: Coronavirus disease; CPR: Cardiopulmonary resuscitation; PICU: Pediatric intensive care unit; PPE: Personal protective equipment.