Written by Hannah Harp
Spoon Feed
This paper summarizes the process of using human-centered design (HCD) to create the prototype of an emergency care action plan (ECAP) for children with medical complexity (CMC).
Getting on the same page
CMC have multiple major health needs or technology dependence, often with ever-evolving medication lists, atypical baseline vitals or exams, and non-standard cardiopulmonary physiology. Since many families of CMC do not live in close proximity to a pediatric tertiary care facility, they may need to seek care at a community ER in case of urgent or emergent needs. General EM providers do not have frequent contact with CMC and deserve a little refresher when kids with metabolic disorders, hypoplastic hearts, or baclofen pumps come into the ER. Having a centralized emergency plan with a patient’s most likely emergency presentations, medications/allergies, specialist contact information, and baseline vitals/exam findings can save precious time during an emergency.
This mixed-methods study used an HCD approach to develop an ECAP for CMC. It engaged key stakeholders, including emergency physicians and caregivers in an iterative process. Key results indicated that ECAP improved care coordination and was preferred in electronic health records (97%). Findings suggest HCD enhances emergency planning tools, facilitating better emergency care for CMC while addressing implementation barriers. Barriers include maintenance and integration challenges. This ECAP hasn’t yet undergone implementation testing, so keep in mind that these improvements to previous emergency information forms are still largely theoretical. The major question I am left with is who will be the “owner” of this document? It would be great for these documents to be collaborative among specialists, PCP, and home nursing. Maybe a next step in the ECAP journey!
How will this change my practice?
Not only will a well-designed ECAP maximize care of a CMC in a community ED, I think it also helps to have a brief overview available at the child’s home tertiary care center. I have found these to be extremely helpful in synthesizing information about my most complicated patients.
Source
Human-Centered Design to Create an Emergency Care Action Plan for Children With Medical Complexity. Pediatrics. 2025 Feb 12:e2024069125. doi: 10.1542/peds.2024-069125. Epub ahead of print. PMID: 39933576
