Improving Emergency Care for Children With Medical Complexity: A Pragmatic Review

Children with medical complexity (CMC) are defined by the presence of significant chronic health problems that affect multiple organ systems, often requiring medical technology, and result in functional limitations and high health care needs, including frequent emergency department (ED) visits. CMC are an estimated 1.5% of the pediatric population in the United States, yet account for 20% of pediatric ED encounters and 33% of total pediatric health care costs. Beyond high utilization, significant challenges in providing high-quality emergency care for CMC have been identified. Communication with other providers and caregivers, extended treatment times, and limited access to data are among major challenges when caring for CMC in the ED. Insights have emerged in recent years to both (1) reduce the need for emergency care through targeted ambulatory care programs, and (2) improve quality of care when CMC do present to the ED. For example, access to next-day ambulatory appointments and 24/7 access to known providers are successful outpatient strategies to reduce ED visits, while efforts for improving care within the ED have focused on the ability to improve access to critical health information for emergency providers through emergency care plans. Future work may include leveraging electronic health records and artificial intelligence to create and manage emergency care plans while improving portability. As this population of children continues to grow, it will be imperative for emergency medicine providers to invest in collaborative care models that prevent acute illness exacerbations, while supporting innovative models to promote high-quality emergency care for this medically and socially vulnerable population.