A Qualitative Needs Assessment for Pediatric Care Partnerships in Community Emergency Departments

Most pediatric emergency care in the United States occurs within community emergency departments (CEDs). CEDs often rely on pediatric academic medical centers (PAMCs) for specialty consultation and care continuation. These collaborations may be conduits for CEDs to enhance delivery of pediatric care. We sought to explore the experiences of CEDs with the provision of pediatric care and their perspectives on ways a PAMC can provide support.

We used phenomenological qualitative techniques to explore lived experiences of health care leaders of CEDs. We purposefully sampled nurse and physician leaders from CEDs with varying pediatric volumes, rural and nonrural designations, and proximity to a PAMC. In semistructured interviews, we explored their experiences of caring for children and views on current and desired PAMC support. We used reflexive thematic analysis to identify themes.

We interviewed 15 nurse and 13 physician leaders representing 13 CEDs. Four major themes were identified: (1) existing pediatric infrastructure impacts care, (2) caring for pediatric patients has a unique emotional and psychological impact, (3) increased PAMC support for CEDs is desired, and (4) expedient interfacility transfer is valued, but challenges in execution exist. Participants cited loss of inhouse pediatric-specific support as challenging and desired partnerships with PAMCs to improve care via linkage to subspecialty care, facilitation of timely transfer, and educational support.

ED leaders at CEDs value the ability to deliver high-quality pediatric care in their settings but often encounter barriers. PAMCs can enhance partnerships with CEDs and help advance optimal pediatric emergency care delivery in these settings.