Background: Feedback is a critical part of learning, patient safety improvement programs and is desired by our general emergency department (GED) colleagues. As part of a statewide strategy to optimize pediatric care in community hospitals, we implemented a novel program to provide follow-up and feedback to GED providers on children transferred to a regional children’s hospital. This study explored stakeholder perspectives on the strengths and challenges of the feedback program, as well as barriers and facilitators to implementation.<
Methods: Seven physician pediatric emergency care coordinators (PECCs) completed one-on-one, semi-structured interviews about their experiences with the feedback program, which had provided follow-up and feedback reports on over 350 transfers from their seven hospitals over a one year period. Five researchers independently coded and analyzed the transcribed data using the constant comparative method of grounded theory. Codes were collectively refined and clustered to develop themes. We conducted member-checking to increase validity.
Results: Seven hours of transcript were coded revealing the following themes. Perceived values of the program included: “closing the loop” on transferred patients; providing education; and informing GED quality assurance initiatives. Participants valued the concise and timely nature of the reports, their empathetic delivery and provision from pediatric emergency medicine (PEM) colleagues with whom they have established relationships. Suggested improvements included: incorporating bidirectional discussions; gathering local and statewide transfer data trends; and focusing on generalizable, evidence-based educational pearls. Key barriers to implementation included potential medicolegal exposure and significant time burdens for both report generation and processing by PECCs. Key facilitators to implementation included collaborative learning efforts like in-situ simulation and a GED culture of self-inquiry.
Conclusion: PECCs participating in our feedback program described many benefits and provided suggestions that may foster successful execution of similar programs throughout the country. Examining data trends in transfer patients may uncover areas of focus as we continue the work to improve the care of children across all emergency care settings.