Rapid Implementation of an Adult COVID-19 Unit in a Children’s Hospital

Philips, Kaitlyn; Uong, Audrey; Buckenmyer, Tara; Cabana, Michael D.; Hsu, Daphne; Katyal, Chhavi; O’Connor, Katherine; Shiminski-Maher, Tania; Hametz, Patricia

Objective To describe the rapid implementation of an adult coronavirus disease 2019 (COVID-19) unit using pediatric physician and nurse providers in a children’s hospital and to examine the characteristics and outcomes of the first 100 adult patients admitted. Study design We describe our approach to surge-in-place at a children’s hospital to meet the local demands of the COVID-19 pandemic. Instead of re-deploying pediatric providers to work with internist-led teams throughout a medical center, pediatric physicians and nurses organized and staffed a 40-bed adult COVID-19 treatment unit within a children’s hospital. We adapted internal medicine protocols, developed screening criteria to select appropriate patients for admission, and reorganized staffing and equipment to accommodate adult COVID-19 patients. We used patient counts and descriptive statistics to report sociodemographic, system, and clinical outcomes. Results The median patient age was 46 years; 69% were male. On admission, 78 (78%) required oxygen supplementation. During hospitalization, 13 (13%) eventually were intubated. Of the first 100 patients, 14 are still admitted to a medical unit, 6 are in the intensive care unit, 74 have been discharged, 4 died after transfer to the ICU, and 2 died on the unit. The median length of stay for discharged or deceased patients was 4 days (IQR 2,7). Conclusions Our pediatric team screened, admitted, and cared for hospitalized adults by leveraging the familiarity of our system, adaptability of our staff, and high-quality infrastructure. This experience may be informative for other healthcare systems that will be re-deploying pediatric providers and nurses to address a regional COVID-19 surge elsewhere.