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Staff Perceptions of Improving Emergency Care for Children

A Qualitative Study

Ratnapalan, Savithiri, MBBS, MEd; Bennett, Chris, BA; Dopson, Sue, PhD; Darwent, Melanie, BM BCh

doi: 10.1097/HCM.0000000000000251

The objective of this study was to identify staff perceptions of a service improvement for pediatric emergency care at a university teaching hospital. Semistructured qualitative interviews of stakeholders were conducted, and grounded theory approach was used for analysis. Forty-one interviews were conducted with physicians, nurses, managers, and health care workers. Major themes emerging from the analysis included the physical space of and flow within the pediatric emergency department (ED), impact of technology, staffing in the ED, the effects of frontline pediatricians and emergency physicians managing children in the ED, and the need for and expectations of a pediatric emergency medicine (PEM) consultant. Human interactions among health care providers, leadership, and teaching are considered as equally important as providing the appropriate environment and qualified professionals for improving care for children in the ED. Appointment of a PEM consultant was suggested to provide leadership and education to manage relationships and implement changes. Subsequent to the study, the model of care for PEM was changed, the pediatric care delivery became more integrated with the main ED, and two PEM consultants were appointed to the institution.

Author Affiliations: Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto; and Divisions of Emergency Medicine, Clinical Pharmacology & Toxicology, Hospital for Sick Children (Dr Ratnapalan), Toronto, Ontario, Canada; Kings College London (Mrs Bennett); and Saïd Business School, University of Oxford (Dr Dopson); and Oxford University Hospitals (Dr Darwent), Oxford, United Kingdom.

This study was supported by the Department of Paediatrics, Oxford University Hospitals, NHS Foundation Trust.

The authors have no conflicts of interest to disclose.

Correspondence: Savithiri Ratnapalan, PhD, MBBS, MEd, Divisions of Emergency Medicine, Clinical Pharmacology & Toxicology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada (

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