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Learning lessons from the paediatric critical care response to the SARS-CoV-2 pandemic in England and Wales: a qualitative study
  1. Emma Roche1,
  2. Chun Lim2,
  3. Meelad Sayma3,
  4. Annakan Navaratnam4,
  5. Peter J Davis5,6,
  6. Padmanabhan Ramnarayan7,8,
  7. James Fraser5,8,
  8. Simon Kenny9,10
  9. Paediatric Critical Care Society (PCCS), NHS England & NHS Improvement
  1. 1Birmingham Women’s and Children’s Hospitals NHS Foundation Trust, Birmingham, UK
  2. 2Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3Whittington Hospital NHS Trust, London, UK
  4. 4University College London Hospitals NHS Foundation Trust, London, UK
  5. 5Bristol Royal Hospital for Children, Paediatric Intensive Care Unit, Bristol, UK
  6. 6NHS England & NHS Improvement, London, UK
  7. 7Children's Acute Transport Service, London, UK
  8. 8Paediatric Critical Care Society, London, UK
  9. 9Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  10. 10Medical Director for Children and Young People, NHS England & NHS Improvement, London, UK
  1. Correspondence to Dr Emma Roche, Birmingham Women’s and Children’s Hospitals NHS Foundation Trust, Birmingham, UK; emma.roche1{at}nhs.net

Abstract

Objectives To explore the experiences of clinical leads in paediatric critical care units (PCCUs) in England and Wales during the reorganisation of services in the initial surge of the SARS-CoV-2 pandemic and to learn lessons for future surges and service planning.

Methods A qualitative study design using semistructured interviews via virtual conferencing was conducted with consultant clinical leads and lead nurses covering 21 PCCUs. Interviews were conducted over a period of 2 weeks, 2 months after the initial SARS-CoV-2 surge. Interview notes underwent thematic analysis.

Results Thematic analysis revealed six themes: leadership, management and planning; communication; workforce development and training; innovation; workforce experience; and infection prevention and control. Leadership was facilitated through clinician-led local autonomy for decision-making and services were better delivered when the workforce was empowered to be flexible in their response. Communication was preferred through collaborative management structures. Further lessons include recognising workforce competencies in surge preparations, the use of virtual technology in facilitating training and meetings, the importance of supporting the well-being of the workforce and the secondary consequences of personal protective equipment use.

Conclusions During the 2020 SARS-CoV-2 pandemic, an agile response to a rapidly changing situation was enabled through effective clinical leadership and an adaptive workforce. Open systems of communication across senior clinical and management teams facilitated service planning. Support for all members of the workforce through implementation of appropriate and innovative education and well-being solutions was vital in sustaining resilience. This learning supports planning for future surge capacity across paediatric critical care locally and nationally.

  • health services research
  • qualitative research

Data availability statement

Data are available upon reasonable request, and where confidentiality to participants can be maintained.

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.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2020-320662

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    Data availability statement

    Data are available upon reasonable request, and where confidentiality to participants can be maintained.

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    Footnotes

    • Collaborators Paediatric Critical Care Society (PCCS), NHS England and NHS Improvement.

    • Contributors ER, CL, MS and AN designed the interview guide, conducted the interviews, performed the data analysis and prepared the first draft of the manuscript. SK, JF and PR revised the interview guide. JF and SK invited participation to interview at national meetings. All authors were involved in revising the manuscript and approved the final version.

    • 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.

    • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

    • Competing interests SK reports personal fees from NHS England and NHS Improvement during the conduct of the study and is an employee of NHS England and NHS Improvement. PJD reports personal fees from NHS England and NHS Improvement, outside the submitted work.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.