405 - Pediatric Emergency Medicine Physicians’ Perspectives on Emergency Care of Children with Medical Complexity (CMC): A Multi-Institution Survey

Poster Number: 405
Publication Number: 405.315

Christian Pulcini, University of Vermont, Shelburne, VT, United States; Amy Dubuque, Intermountain Healthcare, Salt Lake City, UT, United States; Miles Lamberson, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Michelle L. Macy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Rakesh MIstry, University of Colorado School of Medicine, Aurora, CO, United States; Christopher M. Pruitt, Medical University of South Carolina College of Medicine, Charleston, SC, United States; David Schnadower, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Joseph J. Zorc, Children's Hospital of Philadelphia, Wynnewood, PA, United States; Martha W. Stevens, University of Vermont, Larner College of Medicine, Burlington, VT, United States

Background: Children with medical complexity (CMC) compose approximately 1% of the general pediatric population, but account for approximately 20% of all pediatric emergency department (ED) visits. Previous descriptions of the challenges of emergency care of CMC, and interventions to ensure quality of care are limited. Emergency information forms (EIFs) are a suggested method to assist in the ED care for CMC.

Objective: Our objective was to elicit pediatric emergency medicine (PEM) physicians’ perspectives on best practices and opportunities for improvement of emergency care of CMC, with a focus on EIFs.

Design/Methods: 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 a final 18-item survey. Provider demographics were also collected. Data were analyzed with descriptive statistics.

Results: There were 151 respondents who completed the survey. Most respondents (62.9%) reported caring for >10 CMC per month. Pediatric sub-specialty care (90.7%) and complex care teams (63.6%) were available at most sites (Table 1). While overall medical fragility and time constraints were the 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 in providing ED care. Most respondents did not report routine use of EIFs; however, most providers preferred EIFs be available on paper and in the electronic health record (EHR). Anticipated emergencies/action plan was deemed the most important component of EIFs (Table 2).Conclusion(s): Most PEM physicians view the care for CMC in the ED as challenging. Consistent with previous studies, time constraints and medical fragility were seen as a particular challenges. Communication with known providers and EIFs with an action plan were considered as potentially useful solutions to aid in the ED care of CMC. Paper and EHR delivery of action plans using EIFs is preferred by PEM physicians but will require further research to develop and implement these tools.