A Physician-led, Qi-based Approach to Pediatric Disaster Preparedness

Purpose/Objectives: Deficiencies in day-to-day operational readiness are exacerbated during a disaster, disproportionately affecting children. Two 6-month long initiatives were piloted to recognize deficient areas of preparedness and create change strategies to address preparedness for disasters in both pediatric clinics and hospitals. We demonstrate that a physician-led, QI-based approach is an effective strategy to enhance pediatric clinics and hospitals disaster preparedness.

Design/Methods: Pediatric considerations were divided into seven domains (Figure 1 and Figure 2), each domain delineated primary drivers, change strategies, and resources to minimize knowledge barriers and drive improvement. After completing initial quality improvement education, physicians scored their plan in each of the domains using a 6-point scale (max. score 42 pts.). This environmental scan intended to evaluate deficiencies in the participant’s disaster plan. Physicians conducted 4 meetings over the course of 6 months to review improvement strategies. Teams repeated the environmental scan monthly, aiming to achieve at least a 2-point increase per domain or a total score of 30 by the end of the 6 months. Upon completion of the project, participants were eligible for 25 Maintenance of Certification Part 4 credits.

Results: The clinic-based initiative was led from January 1 - June 30, 2020 with 11 registered physicians. The median overall preparedness score increased from 18 (IQR=11.5; n=11), to 38.5 (IQR=6; n=4) at the conclusion of the project, an overall 48.81% (42.86% to 91.67%) increase in total preparedness. The hospital-based initiative was led from June 30 - December 31, 2020 with 71 registered physicians. The median overall preparedness score increased from 14 (IQR=12.5; n=7) to 33.5 (IQR=10.25; n=12) by the conclusion of the project, an overall 46.43% (33.33% to 79.76%) increase in total preparedness.

Conclusion/Discussion: The COVID-19 pandemic affected participation in the project as many participants were tasked with additional duties at their institution. Nonetheless, this model of physician-led preparedness efforts proved to be a successful strategy for improving disaster preparedness of both pediatric clinics and hospitals. Clinic-based physicians focused on vaccine storage. Some purchased generators to ensure safe vaccine storage while others worked with their local hospital pharmacy to store vaccines in the event of a disaster. Others moved their electronic medical records to cloud storage. The hospital-based physicians identified staff education and communication as the most useful domains. This was closely followed by surge planning, many of which were immediately tested by the current pandemic. Others highlighted efforts to improve patient-centered care by improving coordination with social work, administrators, and chaplains to meet patient needs. The next cohort for both the clinic-based and hospital-based initiatives will be launched late summer or early fall 2021. In anticipation of large pediatric COVID-19 vaccination efforts, these cohorts will have a heightened focus on vaccine storage and mass pediatric vaccination strategies.