366 - A Qualitative Study of Barriers and Facilitators to Academic Medical Centers Supporting Community Emergency Departments' Efforts to Improve Pediatric Readiness

Poster Number: 366
Publication Number: 366.524

Background: Community Emergency Departments (CEDs) care for 30 million pediatric patients per year (90% of all ED visits). CEDs with low levels of Pediatric Readiness experience poor pediatric outcomes such as a 4x higher mortality. Formalized collaboration between Academic Medical Centers (AMCs) using AMC champions and CEDs using Pediatric Emergency Care Coordinators (PECCs) is associated with improved pediatric readiness. To date, the AMC champion role lacks standardization nationally.

Objective: The objective of this study was to explore the facilitators and barriers experienced by AMC champions collaborating with CEDs to improve Pediatric Readiness across the US.

Design/Methods: The Consolidated Framework for Implementation Research (CFIR) 2.0, an implementation science framework, was used to guide the development of a qualitative interview guide and a pre-formed codebook that facilitated a deductive coding process. 23 one-on-one qualitative interviews were conducted with AMC champions from 8 states. The codebook was used to deductively analyze transcripts in an iterative process that used thematic analysis to develop a final code list. The code list was refined and revised, and codes were clustered into relevant themes that emphasized training, the implementation process of the AMC champion role, and the adaptability of the AMC champion’s roles and responsibilities. The interview guide and codes are provided in Table 1.

Results: AMC champions (11 physicians, 12 nurses) described internal motivations, based on personal and professional reasons, as the main facilitator of their work to improve pediatric readiness in CEDs. At the Individual Level, a major barrier was that AMC champions did not have protected time nor compensation for their work. At the Inner Setting Level, engaging in pediatric readiness was perceived to be a low priority relative to other initiatives among CED leadership. At the Implementation Process Level, the AMC champion role lacked standardized training and educational resources. Table 2. provides a list of barriers and facilitators to the AMC champion role and supportive quotes.

Conclusion(s): The personal and professional motivation of all AMC champions was the largest facilitator to engaging in pediatric readiness work despite the barriers. Addressing the need for increased leadership support, operationalizing the training process, and advocating for protected time and compensation for AMC champions are key steps to facilitating pediatric readiness work in CEDs across the US.