Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments. Acad Emerg Med 2019 Jul;26(7):803-813
Date
09/30/2018Pubmed ID
30267596DOI
10.1111/acem.13624Scopus ID
2-s2.0-85055708397 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice.
METHODS: This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one-on-one, semistructured interviews. Audio recordings were transcribed and coded by a multi-investigator team drawing on theory produced from comparative analysis.
RESULTS: We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes.
CONCLUSIONS: General ED providers struggled with critically ill children because they could not anticipate their pediatric-specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider-focused interventions to address gaps in pediatric-specific continuing medical education, just-in-time assistance, and knowledge transfer.
Author List
Query LA, Olson KR, Meyer MT, Drendel ALAuthors
Amy L. Drendel DO Interim Chief, Professor in the Pediatrics department at Medical College of WisconsinMichael T. Meyer MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
ChildClinical Competence
Critical Illness
Emergency Medicine
Emergency Service, Hospital
Female
Grounded Theory
Health Knowledge, Attitudes, Practice
Humans
Male
Needs Assessment
Qualitative Research
Wisconsin
