Rapid Implementation of an Adult Coronavirus Disease 2019 Unit in a Children's Hospital

J Pediatr. 2020 Jul:222:22-27. doi: 10.1016/j.jpeds.2020.04.060. Epub 2020 May 4.


Objective: To describe the rapid implementation of an adult coronavirus disease 2019 (COVID-19) unit using pediatric physician and nurse providers in a children's hospital and to examine the characteristics and outcomes of the first 100 adult patients admitted.

Study design: We describe our approach to surge-in-place at a children's hospital to meet the local demands of the COVID-19 pandemic. Instead of redeploying pediatric providers to work with internist-led teams throughout a medical center, pediatric physicians and nurses organized and staffed a 40-bed adult COVID-19 treatment unit within a children's hospital. We adapted internal medicine protocols, developed screening criteria to select appropriate patients for admission, and reorganized staffing and equipment to accommodate adult patients with COVID-19. We used patient counts and descriptive statistics to report sociodemographic, system, and clinical outcomes.

Results: The median patient age was 46 years; 69% were male. On admission, 78 (78%) required oxygen supplementation. During hospitalization, 13 (13%) eventually were intubated. Of the first 100 patients, 14 are still admitted to a medical unit, 6 are in the intensive care unit, 74 have been discharged, 4 died after transfer to the intensive care unit, and 2 died on the unit. The median length of stay for discharged or deceased patients was 4 days (IQR 2, 7).

Conclusions: Our pediatric team screened, admitted, and cared for hospitalized adults by leveraging the familiarity of our system, adaptability of our staff, and high-quality infrastructure. This experience may be informative for other healthcare systems that will be redeploying pediatric providers and nurses to address a regional COVID-19 surge elsewhere.

Keywords: adult management; coronavirus; hospitalization; pediatrics; surge capacity.

MeSH terms

  • Adult
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / therapy*
  • Critical Care / organization & administration*
  • Critical Care / standards
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitals, Pediatric / organization & administration*
  • Humans
  • Intensive Care Units / organization & administration*
  • Internal Medicine / standards
  • Male
  • Middle Aged
  • New York City
  • Outcome Assessment, Health Care
  • Pandemics
  • Pneumonia, Viral / therapy*
  • Respiration, Artificial
  • SARS-CoV-2
  • Surge Capacity / statistics & numerical data*