Ashley A Foster1, Melissa Sundberg2, David N Williams3, Joyce Li4. 1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Electronic address: AAFoster@partners.org. 2. Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA. Electronic address: Melissa.Sundberg@childrens.harvard.edu. 3. Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA. Electronic address: David.Williams3@childrens.harvard.edu. 4. Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA. Electronic address: Joyce.Li@childrens.harvard.edu.
Abstract
OBJECTIVE: The number of children with mental health (MH) conditions who present to the emergency department (ED) is increasing. This study aimed to gain insight into the lived experiences of ED staff caring for children with MH conditions and to understand perceptions of current ED resources and what is needed to optimize care. METHODS: This was a qualitative study informed by complexity science theory utilizing a phenomenological approach. We used purposeful sampling from urban and nonurban EDs with varying pediatric volume. Participants were pediatric emergency care coordinators and other ED staff. Semi-structured interviews were completed. The initial codebook was created using a concept driven approach. Constant comparative analysis and deductive reasoning was employed for thematic analysis. RESULTS: Thematic saturation by consensus was achieved with 24 interviews. Analysis found an overarching theme of moral distress of ED staff, compounded by frustration with barriers to care and perceptions of negative impact on care of other ED patients. Participants suggested the need for creation of patient, caregiver, ED staff, and ED leadership resources to enhance care. CONCLUSIONS: ED staff perceive children with MH conditions experience significant barriers to optimal care in the ED, which causes ED provider moral distress. Additionally, other ED patients are perceived to be subsequently negatively impacted. Our findings highlight urgency for funding for more resources that are dedicated to children in the ED setting to ensure both safe, patient-centered care, and to reduce the distress described by ED staff who care for them.
OBJECTIVE: The number of children with mental health (MH) conditions who present to the emergency department (ED) is increasing. This study aimed to gain insight into the lived experiences of ED staff caring for children with MH conditions and to understand perceptions of current ED resources and what is needed to optimize care. METHODS: This was a qualitative study informed by complexity science theory utilizing a phenomenological approach. We used purposeful sampling from urban and nonurban EDs with varying pediatric volume. Participants were pediatric emergency care coordinators and other ED staff. Semi-structured interviews were completed. The initial codebook was created using a concept driven approach. Constant comparative analysis and deductive reasoning was employed for thematic analysis. RESULTS: Thematic saturation by consensus was achieved with 24 interviews. Analysis found an overarching theme of moral distress of ED staff, compounded by frustration with barriers to care and perceptions of negative impact on care of other ED patients. Participants suggested the need for creation of patient, caregiver, ED staff, and ED leadership resources to enhance care. CONCLUSIONS: ED staff perceive children with MH conditions experience significant barriers to optimal care in the ED, which causes ED provider moral distress. Additionally, other ED patients are perceived to be subsequently negatively impacted. Our findings highlight urgency for funding for more resources that are dedicated to children in the ED setting to ensure both safe, patient-centered care, and to reduce the distress described by ED staff who care for them.