Fellows Launch National Network to Help Pediatric Hospitals Take on Adult COVID-19 Patients

By Karyn Enzweiler

Ashley Jenkins, MD, Hospital Medicine

A crisis is thought to reveal one’s true nature. At Cincinnati Children’s, collaboration has long ranked among our signature traits, and it has shined under the pressure of the COVID-19 pandemic, especially as we prepared to support adult hospitals in the event of a surge in our region.

Preparations and partnership matured into much more and for so many more as adult hospitals in New York City and other hard-hit areas began turning to less-burdened pediatric hospitals for support. From coast-to-coast, pediatric facilities were grappling with similar questions as they planned to provide safe, quality care to adult patients: What specific conditions should or should not be seen in a pediatric system? What should be the age limit of adults cared for? Add the additional hurdle that hospitals that care for children are not precisely equipped for adult care. Much of the furniture and equipment, and many of the medical supplies—from tubing to surgical tools to medications—are child-sized. Meanwhile, the people who specialize in pediatric care certainly received training in the basics of adult medicine early in their education, but most haven't worked day-to-day with adults in years. Cincinnati Children’s had expertise to lean on having developed a clinical care model, staffed by dual-trained internal medicine-pediatrics (Med-Peds) physicians called the Hospital Medicine Adult Care (HMAC) team. The team helps support the safe care of adults hospitalized at Cincinnati Children’s when needed. In true Cincinnati Children’s fashion, we sought to share and learn.

Enter POPCoRN—The Pediatric Overflow Planning Contingency Response Network

This multi-institutional collaboration was started by a pair of Med-Peds fellows who have devoted much of their clinical and research time to the safe transfer of care from pediatric to adult systems as children with chronic health issues grow up. Ashley Jenkins, MD, Hospital Medicine, is based at Cincinnati Children's and the University of Cincinnati Medical Center. Leah Ratner, MD, MS, is based at Boston Children's and Brigham and Women’s Hospitals. What started between them as a series of emails and virtual meetings evolved within about a week into a full-blown network, complete with a related website (popcornetwork.org) and social media presence (@POPCoRNetwork). “It became pretty clear that having a shared space to be able to talk, troubleshoot and get feedback was incredibly helpful and impactful. We thought we should make this opportunity available to everyone,” said Jenkins. “Our mission, which we defined early on, was to help coordinate a national response that really aimed at equitably increasing the capacity to care for adult patients in pediatric facilities through information dissemination, education and a shared community.” The site went live March 30. As of mid-April, more than 300 professionals across the US and beyond have accessed POPCoRN’s virtual community and its tools to make decisions right for their individual hospitals; more than 200 are actively involved in thinking through key questions and concerns. POPCoRN’s working groups include a focus on community hospitals, integrated/mixed hospitals, free-standing children’s hospitals, equity, metrics and outcomes, and educational materials. Marie Pfarr, MD, clinical fellow, Hospital Medicine, has led the work to compile educational resources on the site. “We brainstormed topics we felt were bread-and-butter internal medicine topics that a pediatric provider may not see every day like stroke, chest pain and inpatient diabetes management,” said Pfarr. The group then created a one-page refresher document on what physicians had learned but may not have needed in caring for kids. As of April 10, the Children’s Hospital at Montefiore, Bronx, NY, had admitted more than 60 adult patients. Other pediatric centers in Boston, Detroit, New Orleans and other cities were also taking on adult care and benefitting from the resources of POPCoRN. Cincinnati Children’s prepared for the possibility of taking on adult patients, but so far, there hasn’t been a need for it.

Marie Pfarr, MD, Hospital Medicine

The People Behind the Network

The backbone of POPCoRN including administrative support and management of web content is managed by medical student volunteers. More than 20 other pediatric and Med-Peds fellows, hospitalists, and other providers have stepped up as leaders and organizers, including many from Cincinnati Children’s:

  • Alicia Caldwell, MD, attending physician, Hospital Medicine (HMAC)
  • Sonya Tang Girdwood, MD, PhD, clinical fellow, Hospital Medicine
  • Brian Herbst Jr., MD, medical director of HMAC, Hospital Medicine
  • Jon Janiczek, MD, attending physician, Hospital Medicine (HMAC)
  • Trisha Marshall, MD, clinical fellow, Hospital Medicine
  • Abigail Musial, MD, clinical fellow, Hospital Medicine

Preparing for What’s Next

Most cities are plateauing. With it, new and different questions dominate discussions among the pediatric community as POPCoRN continues to adapt to the situation. How will the healthcare model change in the coming months? How may resources be re-allocated to prepare for an increase in outpatient visits that were postponed in anticipation of a surge? Whatever happens, the founders have high hopes for the future of the network. “Longer term, we’re really hoping that POPCoRN will at least help start a conversation and bridge a gap between pediatric and adult health systems,” said Jenkins. She also wishes to build on the opportunity POPCoRN has personally presented her—to mentor professionals more junior in their careers—and model what she’s learned from her own exemplary mentors in Hospital Medicine. For more information, see the Journal of Hospital Medicine article “Children’s Hospitals Caring for Adults During a Pandemic: Pragmatic Considerations and Approaches.

Leah Ratner, MD, MS, Boston Children's/Brigham and Women's Hospital

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