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One strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12–1.85; p = 0.276). Our analysis illustrates the feasibility of evaluating outcomes of patients who have been cared for in additional, emergency ICU beds, whilst demonstrating comparable outcomes for adults cared for in pediatric and adult units.

simulation is an emerging tool used to test systems, improve patient safety outcomes and prepare staff working in new clinical environments The aim of the study was to use simulated learning events (SLEs) to assess the effect of a new environment on performance, interpersonal skills and system-based practice. As part of the wider paediatric improvement plan, the simulation programme has been used to enhance teamwork and implement a change to maximize patient safety.Five multi-disciplinary SLEs based on paediatric and neonatal emergencies were held over a month following the opening of the new PAU. The simulations were low fidelity and Ten latent errors were identified pertaining to the availability of equipment and medications; all were rectified within 2 weeks. Operational errors were also identified, including unfamiliarity with the new PAU location within the wider emergency team, leading to delayed attendance to the simulation. The time taken to attend the PAU by the anaesthetic team decreased by 69% once the emergency bleep message was amended with location instructions. We observed that, with each SLE, there were successive improvements in teamwork and operational behaviours. The teams were able to familiarize themselves with each other and the new working environment, consequently leading to reduced times on acquiring equipment for the emergency. There were a total of 20 participants from paediatric, anaesthetic and nursing backgrounds. Feedback was received from 55% of participants, of which all agreed or strongly agreed that the SLEs and debriefs contributed to their learning and helped develop their team-working and leadership skills.SLE is an effective tool for systems testing in a new clinical environment and helps to identify potential critical and non-critical safety risks. We will continue to develop our simulation programme to assess a variety of clinical environments and share learning from the latent strengths and errors with the multi-disciplinary team, to improve clinical processes, team working and patient safety outcomes.

BackgroundDuring the first wave of the COVID-19 pandemic our Paediatric Intensive Care Unit (PICU) was one of 7 in the UK to care for adults with COVID-19. This strategy allowed the hospital to expand its adult critical care capacity. Towards the end of the first wave of the pandemic it was clear that PICU staff wanted to know more about the clinical course of the patients they had cared for. This in part reflects the challenges of shift work and also how difficult it was not getting to know patients’ families as we normally would. Staff also wanted an opportunity to reflect as a group on this remarkable period.ObjectivesPaediatrics as a speciality is well known for its strong principles of multi-professional working. ‘Complex patient meetings’ and Morbidity and Mortality meetings are well established within our practice. In addition, many paediatric departments offer reflective practice sessions and debriefs for staff following challenging cases. We aimed to gather as a unit and apply these principles of reflective practice to our work caring for critically ill adults with COVID-19.MethodsThe PICU junior doctors devised and lead a project to present the work of the unit. We collected demographics about the cohort of 23 patients including age, sex, organ support, co-morbidities, length of stay and outcome. The junior doctors wrote a presentation summarising the care of each patient and sought feedback about the specific challenges faced by each professional team within the PICU. Consideration and care were taken in the lead up to the presentation with staff offered more detailed debriefs about particular cases if they wished, knowing that this presentation could raise distressing feelings for some.ResultsWe delivered a remotely held 90-minute presentation to over 150 clinical professionals which addressed the care of each of the 23 adults with COVID-19 admitted to the PICU. The Family Liaison Team shared, with consent, photos and letters from families. The Physiotherapy Team discussed the challenges of proning, including proning injuries and also the rehabilitation needs of our patients. The Nursing Team described the challenges of managing pressure areas. Each patient was considered in their family and social context, as we would normally do for paediatric patients. The presentation considered the wellbeing resources available to our team within the hospital and wider community. The feedback from the PICU staff was overwhelmingly positive, with one senior nurse commenting: ‘it did really feel like an element of closure has been given’.ConclusionsSome of the best elements of paediatric practice are our ability to work together in a multi-professional team and to reflect on the care we have provided. We took these principles and applied them to the care of our adult patients with COVID-19 offering staff an opportunity to reflect on this remarkably different period on our PICU. We believe this presents an opportunity for us to expand our work and skill set supporting critically ill young adults with complex health needs as they transition from paediatric to adult care.