Pediatric Preparedness for the Winter Viral Surge

Column Author: Jennifer L Watts, MD, MPH | Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Associate Professor of Pediatrics, University of Kansas School of Medicine

Mary Haywood, DO | GME Fellowship Education

Column Editor: Chris Day, MD | Pediatric Infectious Diseases; Director, Transplant Infectious Disease Services; Medical Director, Travel Medicine; Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

Last year’s “tripledemic” of flu, COVID-19 and respiratory syncytial virus (RSV) had much of our health care community and resources stretched thin, leading to uncertainty regarding what to expect during this year’s viral season and how best to prepare. This season’s landscape already looks different, however, with the release of new vaccines and preventive strategies, including nirsevimab, a monoclonal antibody that protects children from RSV. Despite these encouraging developments, it is still imperative to adequately prepare for a surge in viral cases during the upcoming winter months.

To help you, our referring providers, effectively prepare for this season, we have highlighted some key resources and tips provided by Children’s Mercy content experts in collaboration with the Pediatric Pandemic Network (PPN), a network of children’s hospitals dedicated to pediatric emergency and disaster preparedness.¹

For the newest RSV prevention, nirsevimab, the following resources include FAQs for providers and parents along with surveillance tools. 

Nirsevimab (Beyfortus) – FAQs for Healthcare Professionals

Empowering Parents and Providers: a Comprehensive Resource Guide for RSV Management with Nirsevimab

For surge preparedness, the following tips serve as practical guidelines to help facilitate discussions about your current workflows and protocols. As always, please remember to tailor them to your specific circumstances and patient population. We understand it’s important to strike a balance between operational requirements and patient wellbeing and safety.

1. Adaptive Patient Flow

• Develop a patient flow strategy for well check vs. sick visits (separate waiting areas, remote check in, etc.).
• Develop clear guidelines for patient triage based on severity and acuity.
• Consider implementing diverse testing mechanisms (e.g., drive-through).
• Expand clinic hours to provide after-hours appointments to help increase capacity.
• Implement efficient check in/check out processes.
• Expand telehealth services to provide care for patients remotely.
• Support families to provide at-home care of patients with respiratory suctioning and home oxygen.

2. Viral Testing Options/Patient Care

• Determine testing priorities and target groups for each viral illness (influenza, RSV, COVID-19 and others that may be included on multiplex PCR panels).
• Discuss appropriate testing strategies and choose appropriate tests based on clinical indication, cost and test performance (antigen testing vs. single pathogen target PCR vs. multiplex PCR).
• Manage testing turnaround time and notifications of testing results.
• Plan and coordinate with the supply chain for limited testing supplies and develop contingencies.

3. Staffing Strategies

• Develop strategies to increase staffing quickly during a surge.
• Plan for staffing shortages due to illness or caregiving.
• Consider implementing team staffing models when necessary to enhance patient ratios.
• Proactively enhance staffing plans to meet future demands.

4. Supply Chain Readiness

• Establish a supply chain contact and address ongoing shortages.
• Collaborate with the laboratory partners to establish effective systems for supply monitoring.
• Plan for procurement and administration of routine childhood vaccines.

5. Communication and Coordination

• Keep all staff members informed about changes, surge plans and protocols.
• Collaborate with community partners including Children’s Mercy Kansas City to streamline patient referrals and transfers.
• Communicate transparently with patients and families about surge-related changes.
• Provide resources to help patients and families understand new processes.

6. Staff Support

• Continue to implement measures to support your staff’s wellbeing and mental health.
• Provide resources for staff to cope with increased workloads and stress.
• Proactively look for ways to reduce inefficiencies in work and reduce barriers to getting work done.

7. Community Engagement

• Encourage vaccination and other preventive measures to reduce the likelihood of surges.

8. Continuous Improvement

• Regularly review and adjust surge plans based on real-time data.
• Conduct post-surge debriefings to identify lessons learned and areas for improvement; update surge plans accordingly.

Remember, being proactive and prepared can make a significant difference in managing patient care effectively during viral outbreaks. Don’t hesitate to lean on and collaborate with your partners, including your team at Children’s Mercy Kansas City.

Reference:

1. Pediatric Pandemic Network (PPN). Pediatric Preparedness for the Winter Viral Surge. The Pediatric Pandemic Network; 2023: 1-2. Accessed October 30, 2023. https://bpb-us-e2.wpmucdn.com/sites.pedspandemicnetwork.org/dist/c/12/files/2023/09/EMS230831_SurgeTips_230904v2.pdf