Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 13;13(4):e059849.
doi: 10.1136/bmjopen-2021-059849.

Secondary impacts of the COVID-19 pandemic at a tertiary children's hospital in Canada: a mixed-methods study

Catherine Diskin  1   2 , Julia Orkin  2   3 , Blossom Dharmaraj  4 , Tanvi Agarwal  4   2 , Arpita Parmar  4 , Kelly McNaughton  5 , Eyal Cohen  4   2   3 , Alia Sunderji  2   6 , David Faraoni  7 , Annie Fecteau  8 , Jason Fischer  2   6 , Jason Maynes  7 , Sanjay Mahant  4   2 , Jeremy Friedman  4   2   3
Affiliations

Secondary impacts of the COVID-19 pandemic at a tertiary children's hospital in Canada: a mixed-methods study

Catherine Diskin et al. BMJ Open. .

Abstract

Objectives: Decisions to pause all non-essential paediatric hospital activities during the initial phase of the COVID-19 pandemic may have led to significant delays, deferrals and disruptions in medical care. This study explores clinical cases where the care of children was perceived by hospital clinicians to have been negatively impacted because of the changes in healthcare delivery attributing to the restrictions placed resulting from the COVID-19 pandemic.

Design and setting: This study used a mixed-methods approach using the following: (1) a quantitative analysis of overall descriptive hospital activity between May and August 2020, and utilisation of data during the study period was performed, and (2) a qualitative multiple-case study design with descriptive thematic analysis of clinician-reported consequences of the COVID-19 pandemic on care provided at a tertiary children's hospital.

Results: Hospital-level utilisation and activity patterns revealed a substantial change to hospital activity including an initial reduction in emergency department attendance by 38% and an increase in ambulatory virtual care from 4% before COVID-19 to 67% between May and August 2020. Two hundred and twelve clinicians reported a total of 116 unique cases. Themes including (1) timeliness of care, (2) disruption of patient-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic emerged, each impacting patients, their families and healthcare providers.

Conclusion: Being aware of the breadth of the impact of the COVID-19 pandemic across all of the identified themes is important to enable the delivery of timely, safe, high-quality, family-centred paediatric care moving forward.

Keywords: COVID-19; health policy; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Emergency department (ED) activity at SickKids (March to August 2019 vs March to August 2020).
Figure 2
Figure 2
Surgical activity at SickKids (March to August 2019 versus March to August 2020).
Figure 3
Figure 3
Ambulatory activity at SickKids (March to August 2019 vs March to August 2020).
See this image and copyright information in PMC

References

    1. Miller GA, Buck CR, Kang CS, et al. . COVID-19 in seattle-early lessons learned. J Am Coll Emerg Physicians Open 2020;1:85–91. 10.1002/emp2.12064 - DOI - PMC - PubMed
    1. Flaxman S, Mishra S, Gandy A, et al. . Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 2020;584:257–61. 10.1038/s41586-020-2405-7 - DOI - PubMed
    1. Flynn-O’Brien KT, Collings AT, Farazi M, et al. . Pediatric injury transfer patterns during the COVID-19 pandemic: an interrupted time series analysis. J Surg Res 2023;281:130–42. 10.1016/j.jss.2022.08.029 - DOI - PMC - PubMed
    1. Dayal D, Gupta S, Raithatha D, et al. . Missing during COVID-19 lockdown: children with onset of type 1 diabetes. Acta Paediatr 2020;109:2144–6. 10.1111/apa.15443 - DOI - PubMed
    1. Bryant DJ, Oo M, Damian AJ. The rise of adverse childhood experiences during the COVID-19 pandemic. Psychol Trauma 2020;12:S193–4. 10.1037/tra0000711 - DOI - PubMed

Publication types