COVID-19: A UK Children's Hospital Experience.

OBJECTIVES: Reports from China relating to coronavirus disease (COVID-19) in children indicate a milder disease course compared with adults. Although a few pediatric COVID-19 reports from other parts of the world exist, there are none from the United Kingdom. We describe the clinical characteristics of children with COVID-19 admitted to a specialist children's hospital in United Kingdom. METHODS: Retrospective case-series of inpatients with a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2, during a 6-week period from March 14 to April 24, 2020. RESULTS: Forty-five children tested positive for severe acute respiratory syndrome coronavirus 2 during the study period. Median (interquartile range) age was 3.5 (0.7-12) years, and 31 (69%) were male. Children with comorbidities constituted 64% (29 of 45) of the study population, including 44% (20 of 45) who were considered "extremely vulnerable." Fever (67%) and cough (55%) were the most common symptoms. High C-reactive protein (>10 mg/L) was observed in 68% (19 of 28). Lymphopenia (<1.2 × 109/L) was observed in 23% (9 of 40) of children, but it was related to coexisting medical conditions in 6 children. Nine children required supplemental oxygen, two of whom received high-flow nasal cannula oxygen; one needed noninvasive ventilation and one child required invasive mechanical ventilation. Median length of stay of children with an admission outcome (n = 42, 93%) was 3 (2-7) days. There were no COVID-19-related deaths. CONCLUSIONS: COVID-19 had a relatively mild course of illness in majority of the hospitalized children that included a subgroup of vulnerable children with significant comorbidities. Confirmation of this in larger nationwide studies of children is required.

Establishing paediatric trainee clinics during the COVID-19 pandemic

BackgroundPaediatric trainees delivering outpatient clinics provides a valuable learning opportunity and forms part of the Royal College of Paediatrics and Child Health (RCPCH) postgraduate paediatric training curriculum. Due to the current COVID-19 pandemic at Birmingham Children’s Hospital it was identified that 2 months into the current post 83% ST4–8 trainees had attended 0 or only 1 clinic. Consequently, outpatient clinics were redesigned to incorporate telephone and video consults as well as continuing some face-to-face consultations.ObjectivesThe aims developed during this quality improvement project included:In a 6–month post, trainees should aim to attend a minimum of 5 clinics.To devise trainee clinics such that it provides a useful learning opportunity with adequate time built in for consultant supervision and to enable supervised learning events (SLEs) to be undertaken.To develop trainee confidence in doing telephone or video clinics.MethodsAn initial 2-week pilot was commenced with involvement of 5 supervising consultants which was subsequently extended. The standard operating procedure (SOP) for how to run a registrar clinic was distributed to trainees along with a clinic rota and supervising consultant. The SOP included:Step by step instructions regarding what to prepare before clinic.How to conduct telephone and video calls using the AccuRx NHS digital accredited system as well as face to face consultations.How to dictate letters and order investigations.We organised regular monthly virtual meetings with consultants, management and the rota co-ordinator to facilitate clinic set up and address any issues. Questionnaires were sent to trainees and patients. Feedback from consultants took the form of a semi-structured interview. Details are available on the RCPCH website https://qicentral.rcpch.ac.uk/projects/systems-of-care/establishing-paediatric-trainee-clinics-during-the-covid-19-pandemic/.Results19 phone clinics and 12 face to face clinics were undertaken by trainees during the 4-month period generating a possible 106 appointments. The number of trainee clinics occurring monthly increased from an average of 2 to 8. All the trainees that completed the rotation had achieved 5 or more clinic attendances even being less than full time (LTFT). 2 trainees did not complete the rotation due to change of job or redeployment back to community. There were improvements in learning with consultant supervision as 14 requests for SLEs were submitted. A trainee survey conducted after clinics revealed confidence in doing a telephone or video consult increased to 8/10 on a rating scale from 5/10. When trainees were asked about advantages or disadvantages some of the comments included ‘different way of working and gaining experience in an outpatient setting’, ‘ease of patient/family to attend but missing out on interaction that face to face clinics may provide’, ‘found completing SLEs easier during clinic’. A patient satisfaction survey revealed 100% felt the doctor listened and concerns were adequately addressed. Consultant feedback via semi structured interview included ‘found watching the trainee do a video consult interesting/enjoyable’, ‘some trainees still feel nervous doing video consults’, ‘supervising trainee clinics remotely easier and not too much added work’.ConclusionsThere was positive feedback received from trainees, consultants and patients. Trainee led induction using the AccuRx NHS digital accredited system has improved uptake. Clearer appointment letters explaining video consultation will also encourage patient participation. During each rotation managing trainee clinics will be given as a task to a trainee. This will help to ensure sustainability so trainees will continue to deliver clinics remotely with one-to-one consultant engagement, supervision and learning. Birmingham Children’s Hospital is looking at redesigning the whole outpatient service to incorporate telemedicine.