Samuels-Kalow Margaret, Boggs Krislyn M, Loo Stephanie S, Swanton Maeve F, Manning William A, Cash Rebecca E, Wolk Courtney B, Alpern Elizabeth R, Michelson Kenneth A, Remick Katherine E, Camargo Carlos A
Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA.
Department of Psychiatry Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA.
J Am Coll Emerg Physicians Open. 2024 May 21;5(3):e13108. doi: 10.1002/emp2.13108. eCollection 2024 Jun.
Pediatric readiness varies widely among emergency departments (EDs). The presence of a pediatric emergency care coordinator (PECC) has been associated with improved pediatric readiness and decreased mortality, but adoption of PECCs has been limited. Our objective was to understand factors associated with PECC implementation in general EDs.
We conducted semistructured qualitative interviews with a purposively sampled set of EDs with and without PECCs. Interviews were completed, transcribed, and coded until thematic saturation was reached. Themes were identified through a consensus process and mapped to the Consolidated Framework for Implementation Research (CFIR).
Twenty-four interviews were conducted and mapped to themes related to innovation, individuals and implementation process, outer setting (health system), and inner setting (hospital/ED). Addressing innovation, individuals, and implementation process, the primary theme was variability in how the PECC role was defined and who was responsible for implementing it. Regarding the outer setting, participants reported that limited system resources affected their ability to implement the PECC role. Key inner setting themes included concerns about limited visit volume, a lack of systems for measuring pediatric quality of care, and significant tension around change.
Implementation of the PECC role appears to be limited by heterogeneous interpretations of the PECC, de-prioritization of pediatrics, and limited system resources. However, many participants described motivation to improve pediatric care and implement the PECC role in context of increasing pediatric visits; they offered strategies for future implementation efforts.
儿科应急准备情况在各急诊科之间差异很大。儿科急诊护理协调员（PECC）的存在与改善儿科应急准备情况及降低死亡率相关，但PECC的采用情况有限。我们的目的是了解综合急诊科实施PECC的相关因素。
我们对一组有和没有PECC的急诊科进行了有目的抽样的半结构化定性访谈。访谈完成、转录并编码，直至达到主题饱和。通过共识过程确定主题，并将其映射到实施研究综合框架（CFIR）。
进行了24次访谈，并将其映射到与创新、个人及实施过程、外部环境（卫生系统）和内部环境（医院/急诊科）相关的主题。在涉及创新、个人及实施过程方面，主要主题是PECC角色定义方式及负责实施该角色的人员存在差异。关于外部环境，参与者报告称系统资源有限影响了他们实施PECC角色的能力。关键的内部环境主题包括对就诊量有限的担忧、缺乏衡量儿科护理质量的系统以及变革带来的巨大压力。
PECC角色的实施似乎受到对PECC的不同解读、儿科工作优先级降低以及系统资源有限的限制。然而，许多参与者描述了在儿科就诊量增加的背景下改善儿科护理并实施PECC角色的动机；他们为未来的实施工作提供了策略。
