Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction

The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PEDs) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models.

Methods

We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based REDCap questionnaire.  The survey was sent via 3 national pediatric emergency medicine distribution lists, with several follow-up reminders.

Results

There were 46 questionnaires included, completed by PED directors from 25 states.  Forty-two sites provided PED volume and admission data for early pandemic (March-July 2020), and a pre-pandemic comparison period (March-July 2019).   Mean PED volume decreased > 32% for each studied month, with a maximum mean reduction of 63.6% (April 2020).  Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020.

During the study period, 33 (71.1%) sites had decreased provider staffing at some point.  Only 3 sites (6.7%) reported decreased faculty protected time.  All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between PED and other units, and added tele-visit shifts.  Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (IQR 25-28).

Of 44 sites hosting medical trainees, 37 (84,1%) reported a decrease in trainee number or elimination altogether.  Thirty (68.2%) sites had restrictions on patient care provision by trainees:  28 (63.6%) affected medical students, 12 (27.3%) affected residents and 2 (4.5%) impacted fellows.  Fifteen sites (34.1 %) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%).

Conclusion

This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models.  During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellow experience largely preserved.  Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.