Connecting physicians to share best practices, problem-solve during the COVID-19 crisis

As health care facilities across the country scramble to treat the influx of COVID-19 patients, hospitals are getting creative with their spaces and personnel. That’s why Boston Children’s Hospital’s Dr. Leah Ratner, MS’10, recently co-founded an organization to help pediatricians and pediatric facilities adapt to treat adult COVID-19 patients during case surges. As the pandemic continues and new facets of the virus are being discovered each day, she’s connecting practitioners across the country to share best practices and problem-solve in real time.

Why did you decide to create POPCoRN (Pediatric Overflow Planning Contingency Response Network)?

I’m a second-year global health fellow at Boston Children’s Hospital, focusing on global health and pediatric to adult transition. Before COVID, I was in Peru, studying tropical diseases at the Gorgas Institute in Lima. But after two months, we got evacuated and I was asked to help with the response here in Boston.

POPCoRN evolved the third week in March, after talking to colleagues in Cincinnati, and realizing how much we could learn from each other and increase capacity within children’s hospitals.  Ashley Jenkins, POPCoRN co-founder, along with her team in Cincinnati, reached out to our team in Boston to brainstorm how to safely implement adult off-loading in our pediatric hospitals. Together with our teams, we realized that we were in a unique position, both being internal medicine doctors as well as pediatricians [known as Med-Peds], with our teams already caring for adults in a pediatric hospital.  We work with young folks with chronic, complex pediatric-onset conditions to support their transition to the adult space. A lot of our patients are the first generation with their disease to live into adulthood, so we work with both the pediatric and adult hospitals to get them the care they need.

That was just as New York City started to surge. Several children’s hospitals in NYC found out that they were going to be taking care of adults just 12 hours before it happened. They needed safe planning, time to educate staff, but there was no time. So we wanted to support them with this newly growing network of physicians from other cities that were preparing for their surges to happen later.

We created dynamic platforms for folks to come together to problem-solve in real time. Our working groups are primarily run by Med-Peds and pediatric trained physicians. Operational working groups are split by the type of system that folks are coming from, such as freestanding pediatric hospitals, integrated hospitals, and community hospitals. A lot of what we do is about operationalizing the health system so there can be safe care for all. We also have an educational materials working group, which has created one-pagers and educational webinars. To help prioritize equity in our response, there is dedicated time to talk about  health equity and justice and how to best integrate it into our response. We’re actively thinking about how we are responding more to those who have less; how to level the playing field in terms of redistributing resources from well-resourced academic hospitals to community hospitals. We’re also focused on tribal health issues and helping the IHS (Indian Health Service).

We’re looking for folks at all levels of training, from undergraduates to senior faculty, to get involved: https://www.popcornetwork.org.

What are the major challenges for pediatricians to take care of older patients?

Pediatricians are responding to a call to action to take care of adult patients in an unprecedented way. They are stepping outside of their comfort zone. It just so happens that it is pediatricians in this moment, but it may very well be internists in the next pandemic. The major challenge is learning how to collaborate in the moment to provide safe and equitable care.

It’s hard for any provider to take care of patients outside of their scope of training. There are different medications, vital signs, comorbidities, guidelines, and ventilator and ICU management for children and adults.

One way to handle this is making hybrid teams comprised of pediatricians and internists, such as residents in internal medicine working with a pediatrician attending physician. Or having pediatricians in general pediatric wards helping with pediatric emergency departments, or doing outpatient virtual visits.

What are the next steps for POPCoRN?

We’re now working on formalizing what we’ve learned over the past weeks during the initial surge. There are likely to be second waves and surges, so how can we be more prepared next time? The biggest thing is making sure we prioritize an equitable approach. Another huge part is realizing how much physician and provider wellness needs to be prioritized.

What we’ve also discovered is that there’s been less of a need for pediatricians and pediatric facilities to flex, than we expected. But the network and groups we’ve created remain valuable because of the dynamically changing needs of our physicians. Our main goal is to be responsive to new challenges using our resources. For example, this week [May 11], we discussed: 1) the new atypical Kawasaki disease presentation in children; 2) how to keep pediatric practices financially viable during this time, especially those that see kids most at risk; and 3) how we support the most vulnerable communities with tools like PPE, staffing, financial resources and shared protocols that fit the needs of that community.

I’m thankful for the network and the communities the network has served—it’s been both an inspiring and humbling way to learn. 

How are you drawing on your Heller MS degree today?

Heller was absolutely formative. I’m so grateful for it, to have that year of being around folks who are absolutely committed to fighting injustice. It fueled so much of my continued advocacy for health equity. The skills I learned from Heller about sustainable development and policy analysis have been absolutely crucial, not only in my global health fellowship but also thinking about how to plan and implement projects within resource-denied settings.

I’ve had a longtime interest in young adults with chronic illness and recognize that in global health, their human right to the highest attainable care is not always met. They’re in a place where the health system is fragmented the most, and it creates extra vulnerability in patients who are already marginalized. Global health funding tends to be prioritized for babies and maternal health, and adolescent and young adult health is often neglected. So it takes a lot of multidisciplinary thinking to support those folks the way they deserve to be supported.