Abstract
Objective
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article Info
Publication History
Published online: September 15, 2020
Accepted:
September 13,
2020
Received:
June 18,
2020
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Academic Pediatric Association
