BackgroundDuring the first wave of the COVID-19 pandemic our Paediatric Intensive Care Unit (PICU) was one of 7 in the UK to care for adults with COVID-19. This strategy allowed the hospital to expand its adult critical care capacity. Towards the end of the first wave of the pandemic it was clear that PICU staff wanted to know more about the clinical course of the patients they had cared for. This in part reflects the challenges of shift work and also how difficult it was not getting to know patients’ families as we normally would. Staff also wanted an opportunity to reflect as a group on this remarkable period.ObjectivesPaediatrics as a speciality is well known for its strong principles of multi-professional working. ‘Complex patient meetings’ and Morbidity and Mortality meetings are well established within our practice. In addition, many paediatric departments offer reflective practice sessions and debriefs for staff following challenging cases. We aimed to gather as a unit and apply these principles of reflective practice to our work caring for critically ill adults with COVID-19.MethodsThe PICU junior doctors devised and lead a project to present the work of the unit. We collected demographics about the cohort of 23 patients including age, sex, organ support, co-morbidities, length of stay and outcome. The junior doctors wrote a presentation summarising the care of each patient and sought feedback about the specific challenges faced by each professional team within the PICU. Consideration and care were taken in the lead up to the presentation with staff offered more detailed debriefs about particular cases if they wished, knowing that this presentation could raise distressing feelings for some.ResultsWe delivered a remotely held 90-minute presentation to over 150 clinical professionals which addressed the care of each of the 23 adults with COVID-19 admitted to the PICU. The Family Liaison Team shared, with consent, photos and letters from families. The Physiotherapy Team discussed the challenges of proning, including proning injuries and also the rehabilitation needs of our patients. The Nursing Team described the challenges of managing pressure areas. Each patient was considered in their family and social context, as we would normally do for paediatric patients. The presentation considered the wellbeing resources available to our team within the hospital and wider community. The feedback from the PICU staff was overwhelmingly positive, with one senior nurse commenting: ‘it did really feel like an element of closure has been given’.ConclusionsSome of the best elements of paediatric practice are our ability to work together in a multi-professional team and to reflect on the care we have provided. We took these principles and applied them to the care of our adult patients with COVID-19 offering staff an opportunity to reflect on this remarkably different period on our PICU. We believe this presents an opportunity for us to expand our work and skill set supporting critically ill young adults with complex health needs as they transition from paediatric to adult care.
Rising to the challenge of COVID-19- how our Paediatric Intensive Care Unit reflected on our experience caring for adults