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Implementing the National Pediatric Readiness Project in Community Emergency Departments: A CFIR 2.0-Guided
Elizabeth Sanseau1, Cage Cochran2, Ibnat Meah3
1Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Insights
Implementing the National Pediatric Readiness Project (NPRP) in general emergency departments requires leadership support, protected time, and structured facilitation from Academic Medical Center Partners. Regional networks are crucial for sustained pediatric emergency readiness.
Area of Science:
- Emergency Medicine
- Implementation Science
- Healthcare Quality Improvement
Background:
- The National Pediatric Readiness Project (NPRP) provides a framework for pediatric emergency readiness.
- Implementation of NPRP in general emergency departments (GEDs) is variable.
- Pediatric Emergency Care Coordinators (PECCs) drive NPRP operationalization, supported by Academic Medical Center (AMC) Partners.
Purpose of the Study:
- To characterize AMC Partners' perceptions of barriers and facilitators to NPRP implementation in GEDs.
- To understand how AMC Partner facilitation supports PECC operationalization.
- To identify factors influencing successful NPRP implementation across diverse settings.
Main Methods:
- Semi-structured interviews with 23 AMC Partners (physicians and nurses) from the ImPACTS collaborative.
- Analysis using the Consolidated Framework for Implementation Research (CFIR 2.0).
- Hybrid thematic analysis organized by CFIR 2.0 domains.
Main Results:
- Implementation determinants spanned all 5 CFIR 2.0 domains.
- Key facilitators included leadership engagement, protected administrative time, and relationship-based facilitation.
- Persistent barriers included workforce instability, role ambiguity, and low pediatric volume.
- AMC Partners acted as boundary spanners, providing site visits, simulation, audit/feedback, and mentorship.
- Absence of regional AMC Partner networks was a critical gap.
Conclusions:
- Successful NPRP implementation necessitates more than PECC designation.
- Leadership support, protected time, and structured AMC Partner facilitation are essential.
- Findings support the development of regional AMC Partner networks to enhance support for GEDs, particularly in community, rural, frontier, and Tribal settings.
Objectives:
The National Pediatric Readiness Project (NPRP) offers an evidence-based framework for pediatric emergency readiness, yet implementation in general emergency departments (GEDs) remains variable. The Pediatric Emergency Care Coordinator (PECC) is the central driver of NPRP operationalization. The Improving Pediatric Acute Care Through Simulation (ImPACTS) collaborative formalized the Academic Medical Center (AMC) Partner role-experienced pediatric emergency clinicians providing structured NPRP implementation support to GED PECCs. We characterized AMC Partners' perceptions of barriers and facilitators to GED NPRP implementation and how AMC Partner facilitation supports PECC operationalization across diverse community settings.
Methods:
Using the Consolidated Framework for Implementation Research (CFIR 2.0), we conducted semi-structured interviews with 23 AMC Partners (11 physicians, 12 nurses) from the 2023 ImPACTS collaborative, analyzed using hybrid thematic analysis organized by CFIR 2.0 domains.
Results:
Implementation determinants spanned all 5 CFIR 2.0 domains. AMC Partners described the NPRP as a legitimizing framework, with GED implementation depending on leadership engagement, protected administrative time, and relationship-based facilitation. Workforce instability, role ambiguity, and low pediatric volume were persistent barriers. AMC Partners functioned as boundary spanners, translating NPRP standards into local action through site visits, simulation-based systems testing, Pediatric Readiness Score audit and feedback, and iterative mentorship. Absence of regional AMC Partner networks was a critical gap.
Conclusions:
Successful NPRP implementation requires more than PECC designation. Leadership support, protected time, and structured AMC Partner facilitation are essential. These findings inform development of regional AMC Partner network models to extend support to community, rural, frontier, and Tribal emergency departments.
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