THE BRAINCHILD of two med-peds hospitalists has in a matter of weeks grown from an e-mail exchange to a nationwide network of more than 400 clinicians. All of them are now working to get ready to care for adult patients in pediatric facilities if and when adult hospitals surge beyond their capacity because of coronavirus.
In March, Ashley Jenkins, MD, a hospitalist with Cincinnati Children’s Hospital Medical Center who splits her time between pediatric and adult hospital medicine, was part of a local team thinking through how their facility could safely handle an overflow of hospitalized adult patients, should that need arise.
“I realized other people might be grappling with that question because many med-peds physicians work to transition pediatric patients with chronic conditions to adult care,” Dr. Jenkins says. Reaching out to her med-peds colleagues around the country, she was put in touch with Leah Ratner, MD, a hospitalist at Boston Children’s Hospital and a global health fellow.
“Nothing that we’re doing is prescriptive.”
~ Leah Ratner, MD Boston Children’s Hospital
“That started our initial conversation.” While their first discussion was meant to exchange ideas about what each of their institutions was doing to prepare for a possible surge, “it became very clear that people in many other places would benefit from having a shared space for this kind of planning,” says Dr. Ratner. As they reached out to colleagues and momentum grew, they decided to create the Pediatric Overflow Planning Contingency Response Network (@POPCoRNetwork).
That network offers a wealth of educational resources as well as virtual working groups and team leadership discussions. Drs. Jenkins and Ratner spoke with Today’s Hospitalist.
Are the clinicians now working with POPCoRNetwork primarily med-peds?
Dr. Ratner: It started out with med-peds. But we now have a huge proportion of pediatric hospitalists, some family medicine physicians and internists, as well as medical students, nursing and advanced practice providers. The network is meant to be a space for clinicians across many disciplines to come together and think collaboratively about the challenges and solutions of planning for their individual institutions. So nothing that we’re doing is prescriptive. While more than 400 people now want to receive our updates, perhaps between 200 and 300 are actively engaged in one of our working groups where they go over what they’re each doing locally and get feedback and ideas.
How often do those virtual working groups meet?
Dr. Jenkins: Usually once a week, and then each group has its own separate listserv where there are ongoing conversations and feedback between meetings.
In early April, our colleagues in pediatric hospitals in New York did begin taking adult patients. They’ve made time to phone into their working group virtual meetings and share what they’ve learned. The type of contingency plans they put together over the previous two weeks often had to change within 24 hours of actually treating adults, so that’s been very helpful for others to hear.
“We need to be more intentional about sharing what we want to do in our own practice with others.”
~ Ashley Jenkins, MD Cincinnati Children’s Hospital Medical Center
Dr. Ratner: The type of operational planning we’re all doing is very context-specific. So we have three separate working groups to target freestanding pediatric hospitals, integrated hospitals—where both pediatric and adult hospitals are part of the same campus— and community facilities.
The needs in each of those settings are very different. They also have to respond differently depending on
the timing of when their cities or towns are going to surge. Our colleagues in New York, for instance, have had to respond in very different ways than those in rural Pennsylvania would have to.
What are some examples of different plans being executed across different settings?
Dr. Jenkins: Adult patients tend to have more comorbidities and medical problems. Think about a pediatric system that has to treat an adult patient with a heart attack. That’s a type of emergency that pediatric systems don’t commonly see nor are they set up to treat.
So they need to think that through. How would they go about making sure they recognize a heart attack, then get that patient to a cath lab and a cardiologist who can do that procedure? If you’re a freestanding children’s hospital, that process is going to be very different than in an integrated system where you may just need to transfer a patient to a different unit.
Dr. Ratner: It’s been very interesting to see both the commonalities across these different systems, as well as the disparate needs. The needs of community hospitals, particularly those in multi-site systems, are very different than rural hospitals that may have only a few pediatric beds. And rural hospitals may have only three or four pediatricians or family physicians on staff. How can those doctors care for all those populations if they have to start taking adult patients during a surge?
And the biggest difficulty we’ve faced is making sure we reach out to—and be responsive to—the needs of rural and vulnerable communities.
How are you doing that outreach?
Dr. Ratner: We’ve reached out to NGOs (non-government organizations), CBOs (community-based organizations), state chapters of medical associations and FQHCs (federally-qualified health centers) to find out which hospitals they work with. We’re trying to find local champions within community facilities to make sure their communities can participate.
Dr. Jenkins: We’ve been very fortunate to have several medical societies get word out about our network. But that’s also led to us having an over-representation of people in academic centers and teaching hospitals. That group is incredibly important because it’s clearly where a lot of patient care happens, but a lot of patient care happens at other sites too. We want to make sure we reach out to those that perhaps don’t have the time or resources to actively seek additional input.
As you create contingency plans for your hospitals and communities, what long-lasting impact might this network have on your practice?
Dr. Jenkins: I think it’s shown us that within hospital medicine, we need to be more intentional about sharing what we do in our own practice with others. We’ve found that people are incredibly receptive and engaged, and they want the opportunity to connect in real time over targeted questions and feedback.
Dr. Ratner: The pandemic has exposed the level of inequity and systematic fragmentation in this country that, as social medicine advocates, we knew was there. But now it’s palpable and terrifying.
I hope this gives us the ability to rewrite a lot of that fragmentation and embedded racism. Right now, in the early parts of this pandemic, it’s just showing us what we already knew: how deeply they exist.
Edward Doyle is Editor of Today’s Hospitalist.Published in the May 2020 issue of Today’s Hospitalist