From the Division of Emergency Medicine, Department of Surgery and Pediatrics.
Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT.
Pediatr Emerg Care. 2022 Aug 1;38(8):e1423-e1427. doi: 10.1097/PEC.0000000000002712. Epub 2022 Apr 18.
Children with medical complexity (CMC) compose 1% of the pediatric population but account for 20% of pediatric emergency department (ED) visits. Previous descriptions of challenges and interventions to ensure quality of care are limited. Our objective was to elicit pediatric emergency medicine (PEM) physicians' perspectives on challenges and opportunities for improvement of emergency care of CMC, with a focus on emergency information forms (EIFs).
We conducted a web-based survey of PEM physicians participating the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. The survey was designed using an expert panel, and subsequently piloted and revised to an 18-item survey. Data were analyzed with descriptive statistics.
One hundred fifty-one of 495 respondents (30%) completed the survey. Most respondents (62.9%) reported caring for >10 CMC per month. Whereas overall medical fragility and time constraints were major contributors to the challenges of caring for CMC in the ED, communication with known providers and shared care plans were identified as particularly helpful. Most respondents did not report routine use of EIFs. Anticipated emergencies/action plan was deemed the most important component of EIFs.
Most PEM physicians view the care for CMC in the ED as challenging despite practicing in high-resource environments. Further research is needed to develop and implement strategies to improve care of CMC in the ED. Understanding experiences of providers in general ED settings is also an important next step given that 80% of CMC present for emergency care outside of major children's hospitals.
患有复杂疾病的儿童（CMC）占儿科人口的 1%，但占儿科急诊部（ED）就诊量的 20%。以前对确保护理质量的挑战和干预措施的描述有限。我们的目的是了解儿科急诊医学（PEM）医师对改善 CMC 急诊护理的挑战和机遇的看法，重点是急诊信息表（EIF）。
我们对参加美国儿科学会急诊医学分部调查名单服务的 PEM 医师进行了一项基于网络的调查。该调查是使用专家小组设计的，随后进行了试点和修订，形成了 18 个项目的调查。使用描述性统计数据对数据进行分析。
在 495 名受访者中，有 151 名（30%）完成了调查。大多数受访者（62.9%）报告每月照顾>10 名 CMC。尽管整体医疗脆弱性和时间限制是在 ED 照顾 CMC 的主要挑战，但与已知提供者的沟通和共同护理计划被认为特别有帮助。大多数受访者没有报告常规使用 EIF。预期紧急情况/行动计划被认为是 EIF 的最重要组成部分。
尽管在高资源环境中执业，大多数 PEM 医师仍认为在 ED 中照顾 CMC 具有挑战性。需要进一步研究制定和实施策略，以改善 ED 中 CMC 的护理。鉴于 80%的 CMC 在儿童医院以外的普通急诊室就诊，了解一般急诊室提供者的经验也是一个重要的下一步。
