Cheryl, Paediatric Hospitalist PA on the frontlines of COVID-19

Cheryl Hirst is a CCPA working as a pediatric hospitalist PA on the CTU inpatient wards at the Health Sciences Centre Children’s Hospital in Winnipeg, Manitoba. She is a 2015 graduate of the University of Manitoba MPAS program.

April 2020 - My name is Cheryl Hirst and I work as a pediatric hospitalist PA on the CTU inpatient wards at the Health Sciences Centre Children’s Hospital in Winnipeg, Manitoba. 

Our story is similar to many: the COVID-19 pandemic has presented multiple challenges to the once-typical way we practise medicine on the inpatient wards.

 As a team, we have worked to overcome these challenges and, in the process, have made some significant changes to how we provide care.  One of these changes is moving to geographic wards. Normally, we function as 3 teams spread out over 4 different wards on 3 floors. 

To allow for separation of staff members and decrease movement across ward locations, each team is now assigned to a specific ward(s).  This also helps streamline communication with nursing and ward managers.  One ward is also designated for COVID suspect or COVID positive patients. Fortunately, we have not had any COVID positive pediatric cases requiring admission to hospital. 

We also have contingency planning to cohort COVID positive patients to a separate 5th ward if the need should arise.  In addition, we have agreed to accept younger adults (under 25) should the adult side run out of medicine beds.   

Another significant change we have made is moving from bedside rounds to table rounds.  There are several rationale for this: it allows team members to practise social distancing, protecting both the care providers and patients and reduces the use for PPE. Pharmacists, subspecialists and allied health care are encouraged to call in virtually via telephone/Zoom/Facetime/Skype.

We are also limiting daily patient interactions with one coordinated visit to include physical exams (limited to specific relevant systems), answer questions, address concerns and discuss any updates and future plans.  This is done with as few providers as possible, maximum of 2. If further communication with the family is needed, we are encouraged to phone them.

The use of PPE has changed almost daily.  Currently we are required to wear a mask and eye protection at all times, only changing if they become soiled, wet or damaged and in between meals.  All patient interactions require a mask, eye protection, gloves and gown, including proper hand hygiene and stethoscope cleaning.

Handovers are limited to necessary care providers only: senior resident, screening resident and overnight resident.  Other house staff may choose to join handover virtually.

We have also made some changes to screening and admitting patients, in particular COVID suspect/positive patients.  We are committed to expedited admission of these patients and are prioritized over other admissions or ward tasks to minimize time spent in the emergency department.  In fact, COVID suspect/positive patients are assessed by the EMO in the ambulance bay and if stable for the floor, are directly transported to the ward.  Deliberate and clear communication has never been more important.

One thing we have not changed is keeping a sense of humor; it is a REQUIREMENT to have fun in pediatrics, pandemic or not.  I know I am not alone in experiencing waves of anxiety working on the front lines but when I get to work, I am reminded of the privilege of getting to practise medicine, in providing the best care I can for my patients and their families, and then I am filled with a sense of peace, that I have a team surrounding me that will keep me safe, has my back and will continue to have fun right alongside me.