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Developing new models of care at speed: learning from healthcare redesign for children with COVID-related multisystem inflammation
  1. C Ronny Cheung1,2,
  2. Anna Finnemore1,
  3. Jennifer Handforth2,3,
  4. Richard Bohmer4,
  5. Nanna Christiansen5,
  6. Owen Miller2,6
  7. Evelina London Children’s Hospital PIMS-TS Clinical and Study Group
    1. 1General Paediatrics, Evelina London Children's Hospital, London, UK
    2. 2King's College London Faculty of Life Sciences and Medicine, London, UK
    3. 3Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
    4. 4Nuffield Trust, London, UK
    5. 5Evelina Pharmacy, Evelina London Children’s Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
    6. 6Paediatric Cardiology, Evelina London Children's Hospital, London, UK
    1. Correspondence to Dr C Ronny Cheung, General Paediatrics, Evelina London Children's Hospital, London SE1 7EH, UK; ronny.cheung{at}


    This article describes the rapid, system-wide reconfiguration of local and network services in response to the newly described paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) (also known as multisystem inflammatory syndrome in children). Developing the model of care for this novel disease, whose natural history, characteristics and treatment options were still unclear, presented distinct challenges.

    We analyse this redesign through the lens of healthcare management science, and outline transferable principles which may be of specific and urgent relevance for paediatricians yet to experience the full impact of the COVID-19 pandemic; and more generally, for those developing a new clinical service or healthcare operating model to manage the sudden emergence of any unanticipated clinical entity. Health service leaders in areas where COVID-19 is, or will soon be, in the ascendancy, and who are anticipating the imminent influx of PIMS-TS, should use these principles and recommendations to plan an agile, responsive and system-wide model of care for these children.

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    This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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    • Collaborators Collaborators in the Evelina London Children’s Hospital PIMS-TS Clinical and Study Group: Julia Kenny, Claire Watterson, Kevin Meesters, Mary-Jo Fogarty, Jonathan Broad, Marie White, Frances Blackburn, Emma Parish, Bianca Tiesman, Nadia Trecchi, John Jackman, Mark Butler, Rohana Ramachandran, Alice Roueche, Chloe Macaulay, Felicity Montgomery, Vinay Shivamurthy, Nick Wilkinson, James Brighouse, Sara Arenas, Mandy Wan, Sujeev Mathur, James Wong, Paraskevi Theocharis, Kirsty Stewart, Saleha Kabir, Kelly Peacock, Kuberan Pushparajah, Alex Savis, Will Regan, Emma Pascall, Aoife Cleary, Mirasol Uy, Hannah Heard, Michael Carter, Shane Tibby, Jon Lillie, Shelley Riphagen, Marilyn MacDougall, Ben Griffths, Xabi Gomez, Gareth Waters, Federico Minen, Andrew Nyman, Miriam Fine Goulden, Mario Sa, Ming Lim, Susan Bryne, Jill Cadwgan, JP Lim, Rahul Singh, Shan Tang, Dan Lumsden, Sam Senior, Sarah McMurtrie, Emily.Foster, Matthew Norridge, Stephanie Emberson, Stacey Marr, Victoria Felton, Chris Reid, Shazia Adalat, Ramnath Balasubramanian, Helen Jones, Jay Alamelu, Baba Insua, Jeff, Jo Howard, (David Rees) - Kings, Moira Cheung, Rui Santos, Haran Jogeesvaran, Heba Elbaaly, Catriona Reid, Dipalee Durve, Carsten Flohr, Danielle Greenblatt, Cristina Psomadakis, Emma Craythorne, Vanessa Albert, Iain Yardley, Kirsty Brennan, Ingrid Wolfe, Julia Forman, Ben Baig, Deborah Woodman, Harriet Coniff, Anne Gordon, Dan Taylor, Olga van der Woude, Alysha McIntosh.

    • Contributors CRC conceived and planned the paper, wrote the first draft, reviewed and revised the draft manuscript. AF, JH and OM conceived and planned the paper, and critically reviewed and revised the draft manuscript. RB and NC critically reviewed and revised the draft manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RB serves as Director of Clinical Leadership Resources, a healthcare improvement consultancy.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. No patient clinical data, identifiable or otherwise, were involved in drafting the paper. Data relating to development of the service described in the paper are available from the corresponding author upon reasonable request.