Developing a Plan to Implement and Offer COVID-19 Testing for Children

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More than a year into the COVID-19 pandemic, much of medical professionals’ focus has been on testing — and now vaccinating — adults. So, where does that leave children?

Not at all out of the equation, say Lizzy Kuhn, MD, a second-year Pediatrics resident, and Dan Herchline, MD, a third-year Hospital Medicine fellow. As part of a multidisciplinary team at Children’s Hospital of Philadelphia (CHOP), Drs. Kuhn and Herchline have developed child-friendly COVID-19 testing.

Lizzy Kuhn, MD and Dan Herchline, MD Lizzy Kuhn, MD and Dan Herchline, MD The idea began during the beginning of the pandemic when adult hospitals were overrun with patients, but children’s hospitals were relatively unaffected. “We wondered: What can we do to support our community and other physicians – right now,” Dr. Kuhn explains.

The result? A team of residents – including Dr. Kuhn – assembled under the leadership of Allison Ballantine, MD, MEd, Associate Chief Medical Officer at CHOP King of Prussia. Together, these doctors helped set up an initial COVID-19 testing site at the Nicholas and Athena Karabots Pediatric Care Center in West Philadelphia.

COVID-19 testing for children

In the summer of 2021, as daycare centers reopened and school was about to restart, the team realized COVID-19 testing was not as easily available for children as it was for adults. To combat this inequity, the team set out to expand testing efforts and increase access.

A multidisciplinary team, including Child Life Specialists Allison Tappon, MS, CCLS, and Melanie Hoynoski, CCLS, CTRS, simulation experts including AnneMarie Monachino, MSN, RN, CPN, CHSE-A, and nursing leaders in SARS-CoV-2 testing, including Tina J. Penrose, MSN, MPH, RN, CPHQ, committed to developing a curriculum to train providers how to perform COVID-19 tests on children and how to talk to young patients in a developmentally appropriate manner.

Dr. Kuhn and Laura Goldstein, MD, a second-year Hospital Medicine fellow, set out to perform a needs assessment. Specifically, they wanted to find out about age requirements for COVID-19 testing at most sites. They discovered many providers were hesitant to perform COVID-19 tests on young children because they didn’t want to “traumatize them during the process.”

Creating a course for providers

It was at this point that Dr. Herchline and Dorene F. Balmer, PhD, Director of Research on Pediatric Education, joined the project to offer their expertise in Medical Education and help develop a course to improve provider comfort in testing the pediatric population.

“I jumped in when Allison [Ballantine] was looking for someone interested in the education piece as it relates to survey design and performing the needs assessment,” says Dr. Herchline.

With a plan to “target existing infrastructure,” the team had conversations with a variety of organizations and testing sites to learn how to tailor the project so they could best serve them and align the education piece with their desired outcomes, including positive health outcomes and helping providers feel more comfortable testing children.

From there, the team laid out its goals and objectives before completing an in-person pilot using didactics and simulation with real-time feedback, Dr. Kuhn said. “We were looking at it with an eye on how to convert the in-person pilot to online modules,” she said. In addition to the needs assessment, the team also created a survey to measure improvements.

Feedback from the field

Initial feedback from providers indicated that they appreciated having “a developmental framework” that could guide the process of explaining and performing the test on specific age or developmental groups. They also indicated a desire for an online educational module they could access anytime or anywhere.

The team used this feedback to update the online modules – allowing providers to spend more or less time on any specific area of content. Because providers had varying levels of experience testing children and infants, their educational needs also differed.

In reviewing data gathered from the project, the team learned their project did have a substantial impact on providers. Dr. Kuhn reports a “statistically significant, increased comfort among providers” catering to four distinct age groups: infants, toddler/pre-school, school-aged, and adolescents. There were also important geographic learnings, with users from various parts of the United States and the world accessing the online training modules.

What’s next?

Drs. Kuhn and Herchline’s research will be featured on CHOP’s Center for Leadership and Innovation in Medical Education (CLIME) site and the Association of American Medical Colleges (AAMC) website. In addition, the doctors plan to present their work at the 2021 Pediatric Academic Societies Virtual Conference and submit a manuscript to a peer-reviewed journal.

The most important takeaway for their work, shares Dr. Herchline, is the multidisciplinary effort involved. “When you can break down the silos and really work with providers from Nursing and Child Life, as well as Marketing and Operations, that’s when you get some pretty amazing results.”

View Child-Friendly SARS-CoV-2 Testing Training for more details.

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