Several children's hospitals are working to ensure the health care system is better prepared for future emergencies following challenges presented by the COVID-19 pandemic.
University Hospitals Rainbow Babies & Children's Hospital is leading a group of five children's hospitals in a Regional Pediatric Pandemic Network (RPPN) to bolster preparedness in pediatric medicine across the health care system for future pandemics, natural disasters and more.
"More than 80% of emergencies—acute injuries and illnesses—in children don't present to the children's hospitals, they present to community hospitals," says Charles Macias, M.D., M.P.H., chief, pediatric emergency medicine and chief quality officer at UH Rainbow.
"We must support structures and processes that are going to create an even level of care across the country by engaging our community partners to expand their reach, their programs and their knowledge."
Network aims to improve readiness beyond crises
The Health Resources and Services Administration (HRSA) recently awarded a grant of more than $48 million to UH Rainbow to establish the RPPN. Macias is a principal investigator of the HRSA grant, leading a team from UH Rainbow and four other children's hospitals:
- UCSF Benioff Children's Hospital in San Francisco, California
- Norton Children's Hospital in Louisville, Kentucky
- Intermountain Primary Children's Hospital in Salt Lake City, Utah
- SSM Health Cardinal Glennon Children's Hospital in St. Louis, Missouri
By representing broad geographical areas around the country, the network will serve as a hub-and-spoke model to provide expertise and support efforts for pediatric readiness and disaster preparedness in communities throughout the nation.
Leveraging guidelines supported by HRSA, the Office of the Assistant Secretary for Preparedness and Response (ASPR), Emergency Medical Services for Children (EMSC) and other existing workgroups, the RPPN will set out to establish best practices in specific areas, such as trauma, equity and analytics.
While the primary purpose of the RPPN is to elevate crisis preparedness, the initiatives should improve pediatric health outcomes across the board. "The concept of ‘pediatric readiness' is everyday pediatric readiness—you've got all the right equipment, all the right supplies, you're trained and comfortable with how to manage children," Macias says. "Then, when a child happens to come in one day who is really sick and in need of resuscitation, you're prepared."
COVID-19 accelerated foundational knowledge for RPPN
Fortunately, Macias and his colleagues won't have to undertake this endeavor from scratch. In 2019, UH Rainbow led an effort to establish the Eastern Great Lakes Pediatric Consortium for Disaster Response (EGLPCDR). With ASPR's support, and in collaboration with five other children's hospitals in Michigan and Ohio, the EGLPCDR laid the groundwork on a multi-pronged approach to address gaps across the disaster cycle spectrum of mitigation, preparedness, response and recovery in the region.
The EGLPCDR launched in the fall of 2019—just months before onset of COVID-19 in the U.S. Macias says the pandemic shifted the consortium's focus from an academic exercise to a real-life scenario—and made its findings much more valuable.
"We had to pivot from things we were creating theoretically to things that were necessary to identify in real time," Macias says. "We've learned so much about how we can supply better access to care through telehealth and digital optimization as well as capacity and capability building. The pandemic took a lot of the activities that were on our menu—the creation of frameworks, strategies and potential solutions—to real time."
Cooperation critical to initiative's success
Macias says there are many challenges inherent to establishing a national health care emergency preparedness network—chief among them: devising standardized measures of disaster preparedness and navigating legal and regulatory hurdles around interstate portability of patients and their data. "Disasters and pandemics don't respect state lines," Macias says.
Key to the initiative's success, he says, is the quality of its partnerships—not just among pediatric health care institutions but across all community stakeholders.
"The solutions to pediatric readiness are only going to come from an alignment of priorities and collaboration across private and public partnerships, professional societies, associations and all the entities that influence children—we all have to unite," Macias says. "It's about aligning our efforts for greater efficiency and greater effectiveness—that's critical to making certain we get the most value out of our investments."