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Improving Emergency Care for Children With Medical Complexity: Parent and Physicians' Perspectives.

Authors
  • Pulcini, Christian D1
  • Belardo, Zoe2
  • Ketterer, Tara3
  • Zorc, Joseph J3
  • Mollen, Cynthia J3
  • 1 Department of Surgery & Pediatrics, University of Vermont Medical Center and Children's Hospital, University of Vermont Larner College of Medicine (CD Pulcini) Burlington, VT. Electronic address: [email protected]
  • 2 University of Pennsylvania (Z Belardo), Philadelphia, Pa.
  • 3 Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa.
Type
Published Article
Journal
Academic pediatrics
Publication Date
Apr 01, 2021
Volume
21
Issue
3
Pages
513–520
Identifiers
DOI: 10.1016/j.acap.2020.09.006
PMID: 32947009
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved. We performed semistructured interviews with parents and PEM physicians at a single academic, children's hospital. English-speaking parents were selected utilizing a standard definition of CMC during an ED visit in which their child was admitted to the hospital. All PEM physicians were eligible. We developed separate interview guides utilizing open-ended questions. The trained study team developed and modified a coding tree through an iterative process, double-coded transcripts, monitored inter-rater reliability to ensure adherence, and performed thematic analysis. Twenty interviews of parents of CMC and 16 of PEM physicians were necessary for saturation. Parents identified specific challenges related to ED care of their children involving time, information gathering, logistics/convenience, and multifaceted communication between health teams and parents. PEM physicians identified time, data accessibility and availability, and communication as inter-related challenges in caring for CMC in the ED. Suggestions reflected potential solutions to the challenges identified. Time, data, and communication challenges were the main focus for both parents and PEM physicians, and suggestions mirrored these challenges. Further research and quality improvement efforts to better characterize and mitigate the identified challenges could be of value for this vulnerable population. Copyright © 2021. Published by Elsevier Inc.

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