Rutland Emily, Bugaighis Mona, Cruz Andrea T, Goyal Monika K, Mistry Rakesh D, Reed Jennifer L, Santelli John S, Dayan Peter S, Chernick Lauren S
Columbia Vagelos College of Physicians and Surgeons, New York, New York, USA.
Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Acad Emerg Med. 2025 Apr;32(4):434-443. doi: 10.1111/acem.15043. Epub 2024 Nov 5.
Adolescents frequently use the emergency department (ED) to meet their health care needs, and many use the ED as their primary source of care. The ED is therefore well situated to provide preventive health care to large numbers of adolescents. The objective of this multicenter qualitative analysis was to identify factors that influence the implementation of preventive health care interventions for adolescent patients in the ED.
We conducted semistructured interviews with ED health care providers (HCPs) from five academic pediatric EDs in distinct geographic regions. We developed an interview guide to explore HCP attitudes and beliefs related to implementing preventive health interventions in the ED. Interviews were recorded, transcribed, and coded by three investigators. The Consolidated Framework for Implementation Research (CFIR) was used as a guide to code and analyze interview data. We collaboratively generated themes that represent factors that are perceived to facilitate the implementation of preventive health interventions for adolescent patients in the ED setting.
We conducted 38 interviews (18 pediatric emergency medicine attendings/fellows, 11 registered nurses, five nurse practitioners, or and four physician assistants). We generated 10 themes across the five CFIR domains: innovation characteristics (designing interventions to promote adolescent engagement), inner setting (integrating interventions into ED workflow and scope, minimizing provider burden), outer setting (involving the community, aligning with departmental and institutional missions), individuals (identifying champions), and implementation process (involving key stakeholders early, having patience, and targeting all patients to reduce stigma).
Factors facilitating implementation of preventive health interventions for adolescent patients in the ED encompassed multiple CFIR domains, elucidating how the delivery of preventive health interventions for this patient population in the ED requires considering numerous factors comprehensively. These data suggest methods to enhance and facilitate implementation of preventive health interventions for adolescents in the ED.
青少年经常利用急诊科（ED）来满足他们的医疗保健需求，许多人将急诊科作为其主要的医疗服务来源。因此，急诊科非常适合为大量青少年提供预防性医疗保健。这项多中心定性分析的目的是确定影响急诊科为青少年患者实施预防性医疗保健干预措施的因素。
我们对来自不同地理区域的五家学术性儿科急诊科的急诊科医疗服务提供者（HCPs）进行了半结构化访谈。我们制定了一份访谈指南，以探讨HCPs对在急诊科实施预防性健康干预措施的态度和信念。访谈由三名研究人员进行记录、转录和编码。实施研究综合框架（CFIR）被用作编码和分析访谈数据的指南。我们共同生成了代表被认为有助于在急诊科环境中为青少年患者实施预防性健康干预措施的因素的主题。
我们进行了38次访谈（18名儿科急诊医学主治医师/研究员、11名注册护士、5名执业护士和4名医师助理）。我们在CFIR的五个领域中生成了10个主题：创新特征（设计促进青少年参与的干预措施）、内部环境（将干预措施整合到急诊科工作流程和范围中，减轻提供者负担）、外部环境（让社区参与，与部门和机构使命保持一致）、个人（确定倡导者）以及实施过程（尽早让关键利益相关者参与，保持耐心，并针对所有患者以减少污名化）。
促进急诊科为青少年患者实施预防性健康干预措施的因素涵盖了CFIR的多个领域，阐明了在急诊科为该患者群体提供预防性健康干预措施需要全面考虑众多因素。这些数据提出了加强和促进急诊科为青少年实施预防性健康干预措施的方法。
