key: cord-1024958-hdhjc315
authors: Gritz, Andrea; Daniels, Richard; Chodhari, Rahul
title: Challenges to paediatric services during COVID-19 Pandemic: a London, UK perspective
date: 2020-06-25
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.06.025
sha: e7cded0b4c266690e74b535974106f15b04d2930
doc_id: 1024958
cord_uid: hdhjc315

nan

Telemedicine 24

Burnout 25 Gritz 2

Perspective 27 28 To the Editor: 29

Bansal et al's paper 1 on clinician wellness is a welcome addition to the growing canon 30 highlighting the importance of maintaining a psychologically healthy workforce. We identify 31 with the COVID-19 challenges to wellness, including the new anxiety around staff mortality 32 that the article highlights so well and wish to provide a paediatric trainee perspective 33 regarding the adjustments that have been made thus far to mitigate some significant changes 34 to service provision and training. 35

In the north London paediatric network to which we belong, we have witnessed an 37 unprecedented reconfiguration of paediatric services, with the temporary closure of two 38 paediatric emergency departments and five inpatient paediatric wards. Whilst this has 39 enabled the crucial re-deployment of nursing and medical colleagues to areas of highest need, 40 with up to 10% of the paediatric medical workforce unable to work due to sickness or self-41 isolation 2 , there has been a striking diminution of the familiar teams we once worked 42 alongside. Still, adversity often breeds creativity and the challenges faced have proffered new 43 avenues. Our service has rapidly adapted to telemedicine clinics and clinicians shielding due 44 to heightened vulnerability to COVID-19 have been reassigned to this alternative model. The 45 trainee rota has been rationalised, with strategic adjustments made to reduce the risk of 46 burnout. The rapid creation of new regional hubs for Paediatric Ambulatory Care and Mental 47

Health Services have been successful in diverting those requiring dedicated but non-acute 48 care away from the increased risk of COVID-19, whilst ensuring the needs of its stakeholders 49 continue to be met. Alongside this has been a more explicit focus on clinician wellbeing, with innovative approaches embraced. Who could have envisaged several months ago, that newly-51 grounded cabin crew from the aviation industry would customise a 'First Class Lounge' area 52 of the hospital coffee shop, bestowing their free time, kindness and to those inclined, valuable 53 crisis resource skills, to hospital staff seeking a short break. 54

In common with other specialties, there has been widespread disruption to paediatric training 56 in the UK, with examinations and courses critical for career progression on hold. With the 57 added challenge of reaching those trainees temporarily dispersed elsewhere, a co-ordinated 58 approach to meet training needs via regional networks has been adopted. Virtual teaching has 59 been wholly embraced, with the incidental benefit of capturing a greater audience due to its 60 ability to be recorded and then watched at a more convenient time. 61

We are hopeful that the focus on clinician wellbeing can be maintained, even as the acute 63 stresses of working in a pandemic dissipate. Organisations that have a genuine culture of staff 64 wellbeing at their core often do better with recruitment, retention and productivity, all 65 essential qualities for a sustainable, high-quality health service. The gains may indeed have 66 been borne out of hardship, but we should look towards the future, embracing the changes 67 made to improving clinician wellness. 

Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual Challenges for the Allergist/Immunologist

2 Impact of COVID-19 on Child Health Services Tool; RCPCH