With Poise And Grace: Caring for the sickest children in the strangest times
Published on in Children's View
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Published on in Children's View
You might for a moment think you’ve stumbled onto the set of a sci-fi movie. Doctors, nurses and other staff are barely recognizable clothed in isolation gowns and special hoods that cover their heads and shoulders. Conversation takes place via iPad, as the noise from air continuously pumped into each hood makes verbal communication impossible.
Despite being swathed in layers of personal protective equipment (PPE), with diminished hearing and partially obscured vision, these clinicians are performing delicate procedures and lifesaving treatments — expertly and safely.
This is life inside the Pediatric Special Treatment Unit at Children’s Hospital of Philadelphia.
Pandemic or no pandemic, children still need care for a host of devastating illnesses. Since the advent of COVID-19, a priority at Children’s Hospital has been determining how to manage incoming patients who are seriously ill with other conditions, while maintaining the safety of all — patients, families and staff.
Back in 2014, during the Ebola outbreak, staff identified a small area on the hospital’s seventh floor that could be transformed into an isolation unit should patients with that virus come to CHOP. Here, children could receive the care they needed without danger of infecting others. A core team of clinician volunteers underwent special training in the safety procedures necessary to staff the unit.
That preparation proved vital in 2020.
As planning for the COVID-19 response got underway in January, the idea of the isolation unit was revived. The volunteer team was reactivated, and within days, it was operational. As now set up, the Pediatric Special Treatment Unit (PSTU) comprises eight beds.
All patients arriving at CHOP are screened for either symptoms of or exposure to COVID-19. Those deemed at risk, whatever their primary diagnosis, are admitted to the PSTU until testing confirms or rules out the virus.
While they await those results, a lot can happen. And the PSTU team is ready.
“It’s like a mini OR, a mini N/IICU and a mini PICU,” says Jean Anne Cieplinski, RN, MSN, NEA-BC, Senior Director, Critical Care Nursing. Care has ranged from placing a newborn on ECMO — a complex procedure attaching the body to a circuit that takes over heart and lung function — to performing a full resuscitation on a teenager whose condition suddenly deteriorated upon admission.
When specialized expertise is needed, team members from that area of the hospital receive in-the-moment training on the unit’s safety protocols, so they can perform procedures at the bedside. Staff designated as PPE monitors help each clinician don and remove their garb properly.
Exploring unfamiliar territory is not at all unfamiliar to CHOP caregivers — it’s what has made the hospital a world leader over 165 years. “We see a new diagnosis that’s never been identified, a problem that’s not been solved, and we figure it out,” says Shannon Boyle, RN, BSN, CCRN, Clinical Supervisor, Pediatric Intensive Care Unit. That attitude pervades the PSTU, as the team plans, refines, adapts and innovates to find new ways of caring for patients.
In the coming months, staff anticipate another wave of COVID-19 infections, and with it, the ongoing need for the PSTU. Cieplinski takes a moment to reflect: “When I look at what we’ve done in the past few months — the way people have stepped up to care for our patients with such poise and grace — I am so very proud.” And so very prepared.
— Helen Corning