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Pediatric Emergency Medicine Physicians' Perspectives on Emergency Care of Children With Medical Complexity: A

Christian D Pulcini1, Amy Dubuque2, Miles Lamberson2

  • 1From the Division of Emergency Medicine, Department of Surgery and Pediatrics.

Pediatric Emergency Care
|April 18, 2022
PubMed

Insights

Pediatric emergency medicine physicians find caring for children with medical complexity (CMC) challenging, citing fragility and time constraints. Improved communication and shared care plans, along with emergency information forms (EIFs), are key to enhancing emergency care for CMC.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Delivery for Complex Conditions
  • Health Services Research

Background:

  • Children with medical complexity (CMC) represent a significant burden on pediatric emergency departments (EDs), accounting for 20% of visits despite being 1% of the population.
  • Existing literature on challenges and interventions for CMC in the ED is limited.
  • Pediatric emergency medicine (PEM) physicians' perspectives are crucial for understanding and improving care for this vulnerable population.

Purpose of the Study:

  • To investigate PEM physicians' views on the difficulties and potential improvements in emergency care for CMC.
  • To specifically explore the role and utility of emergency information forms (EIFs) in managing CMC during ED visits.

Main Methods:

  • A web-based survey was distributed to PEM physicians via the American Academy of Pediatrics Section on Emergency Medicine Survey listserv.
  • The survey instrument was developed by an expert panel, piloted, and finalized into an 18-item questionnaire.
  • Descriptive statistics were used to analyze the data from 151 respondents.

Main Results:

  • Over 60% of surveyed physicians manage more than 10 CMC patients monthly.
  • Medical fragility and time limitations were identified as primary challenges; enhanced communication and shared care plans were noted as beneficial.
  • Routine use of EIFs was uncommon, though an anticipated emergencies/action plan component was considered highly important.

Conclusions:

  • PEM physicians perceive emergency care for CMC as challenging, even in well-resourced settings.
  • Further research is essential to develop and implement effective strategies for improving ED care for CMC.
  • Understanding the experiences of providers in general ED settings is critical, as most CMC receive emergency care outside specialized children's hospitals.
Abstract

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