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5 strategies to keep high-risk populations safe during disasters

 By Margarita Gil & Racquel Arden

 The rapid spread of COVID-19 put healthcare institutions around the country on high alert, with special emphasis placed on those Americans deemed to be most vulnerable or with pre-existing conditions. But what happens when your entire hospital is filled with patients who fit that criteria?

Such was the challenge faced at Totally Kids Rehabilitation Hospital. Serving children and their families for nearly half a century, Totally Kids provides complex medical care and treatment to children, adolescents and young adults who are recovering from physical trauma or surgery, have suffered catastrophic illness or who are dependent on technology. Programs include pediatric acute rehabilitation, pediatric subacute, and pediatric intermediate care.

As soon as the coronavirus was barely a blip on anyone’s radar, it was apparent that given Totally Kids’ patient population the challenges could be enormous. Here are five tips based on what we’ve done to keep our patients and staff safe:

  1. Get a good structure in place right away: We immediately initiated daily incident command briefings with particular focus on: exposure mitigation strategies (entry access, COVID-19 screening, visitation management); staffing ( shortage, assignments, education, communication); supplies (need, usage, alternatives); space (social distancing, isolation, surges), and; community outreach (parents, referrers, volunteers and local agencies). Now many months in we continue to meet regularly to ensure that all of the precautions we have put in place are being practiced daily. In addition, we remain in close contact with local, state and federal authorities, including the County Public Health Department, to stay abreast of the latest outbreak information and to follow the latest practices to limit the spread of COVID-19.


  1. Communication is key: Knowing the concerns parents would have, we contacted the parents of each of our patients to let them know what we were doing to protect the health of their child and to minimize the spread of COVID-19. We called the families directly, sent letters, developed a Frequently Asked Questions document and set up a hotline for parents to call at any time with questions.


Similarly, we expanded our communication efforts with referral sources and staff. We informed referrers of the safety precautions put in place and our strict adherence to CDC guidelines and invited their input while assuring them that patient safety is our highest priority. For our own staff, we shared CDC information and provided education on the virus including how to minimize its spread and how to keep themselves and their families safe. In addition, we arranged to have the local public health taskforce provide onsite education and provide individual emotional support to relieve any fears.

  1. Focus on infection control and supplies: Like all hospitals, Totally Kids rapidly implemented strict infection control policies and followed CDC guidelines for social distancing (including creating extra break room space), hand washing (extra hand hygiene stations and a portable hand wash station outside of the hospital entrance) and proper use of PPE. We instituted new internal controls regarding the cleaning and access to lab and radiology equipment as well as new safety precautions for employees in those departments. And we are continuing to test staff and have procedures in place so that staff and patients can be notified should COVID-related events occur that affect them.

We also had to address access to supplies which quickly became an issue given worldwide shortages. Our strategy focused on inventory management and acquisition of supplies, and included encouraging both staff and local volunteers to make masks and reusable gowns. The outpouring of support was tremendous.

  1. Limit campus access: We set up screening protocols in our reception area and allowed only a single entrance into our facility. We also limited visitations and movement on campus, including restricting access to medical students and non-essential consultants/vendors. All family visits to our DP-SNF (subacute) unit and Circlebrook Intermediate Care Facility were initially restricted completely. Given that we have always encouraged families to become active participants in their children’s care these restrictions were painful to enact but necessary to ensure safety. We immediately initiated Skype and window visits for families to keep in contact with their child and have now implemented face-to-face visitation for parents in a controlled space without entering the hospital. Doing so is part of our commitment to find ways to bring children and their parents back together and to revive the touch and tenderness that makes families whole.


  1. Be willing to make tough decisions: A painful but prudent action was to suspend our operations at KidShip. This unique preschool program brings medically fragile or developmentally delayed children together with kids without disabilities to play and learn in one supportive setting. Given that KidShip’s children include those with feeding tubes or catherization, those who are oxygen dependent, and those who require diabetic or ostomy care, suspending this program until further notice is, we believe, in the best interest of the health and safety of our students’ families and our team members.

Caring for children is a sacred bond—made even more so when these children are dependent on us for care during these most unusual times. Children’s hospitals around the country are answering this call with unprecedented resiliency and we are proud to be part of that fraternity. For we believe, as Fred Rogers said, that “anyone who does anything to help a child is a hero to me.”

Margarita Gil, MSN, RN, CRRN is vice president of patient care services and Racquel Arden, MA, RRT, HACP, CPHRM is vice president of regulatory compliance at Totally Kids Rehabilitation Hospital in Southern California.









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