Challenges to Caring for Injured Children With Special Health Care Needs in Emergency Settings

BACKGROUND AND OBJECTIVES: Injured children and youth with special health care needs (CYSHCN) can present competing priorities for prehospital and hospital care. Clinicians must balance the potential impact of chronic conditions—such as attention-deficit/hyperactivity disorder, autism, diabetes, or depression—with concerns about acute injury treatment for CYSHCN. The objective of this study is to identify the organizational and macro-level challenges and opportunities that clinicians face when caring for injured CYSHCN in acute care settings. METHODS: We conducted qualitative interviews (N = 36) with prehospital and hospital clinicians that serve the level 1 trauma centers in 1 metropolitan region in the Northeastern United States and treat patients aged younger than 19 years. The interviews were recorded, transcribed, and analyzed through rapid analysis to identify themes as well as suggestions for recommendations to improve care. RESULTS: We identified 4 themes that corresponded with organization-level factors: multidisciplinary care coordination; staffing and skill alignment; protocols, policies, and practices in conflict with patient care; and competing organizational needs. Additionally, clinicians listed myriad inter-organizational, regulatory, and societal factors that varied based on the specific context. CONCLUSIONS: Five recommendations are presented based on the identified themes, grounded in improving care quality for CYSHCN: developing protocols to enable coordination and follow-up across disciplines; ensuring that staff are trained to handle dual priorities; engaging trained staff and resources; reviewing organizational protocols, policies, and practices to better accommodate CYSHCN and their families; and galvanizing organizational buy-in for change. In a future study, we will engage family caregivers to inform these recommendations.