P2.172: “The resources are so far, and you need them right here”: A Qualitative Study on Caring for Violently Injured Youth in the Emergency Department

Background: When youth sustain violent injuries, the Emergency Department (ED) is often their entry point into the healthcare system. Following an ED or hospital visit for violent injury, interventions such as care coordination and connection to community-based resources are associated with improved outcomes among youth, yet comprehensive care outside of direct medical needs is not consistently integrated into standard ED workflows. The objective of this study was to determine the barriers and facilitators to providing comprehensive care for youth with violent injuries in general and pediatric EDs.

Methods: We conducted an exploratory qualitative study through semi-structured interviews with pediatric and general ED physicians and nurses to understand barriers and facilitators that exist in providing comprehensive care for children with violent injuries (specifically suicide attempts and firearm injuries) in the ED setting. Participants were recruited from eight states with geographic and population diversity (Arkansas, Florida, Iowa, Maryland, Nebraska, New York, Vermont and Wisconsin) using the National ED Inventory database from October 2023 to May 2024. Qualitative analysis occurred iteratively using a constant comparative approach with combined inductive and deductive coding to identify recurring themes. Interviews continued until thematic sufficiency was achieved and no new themes were identified.

Results: We conducted 13 interviews: 8 from pediatric EDs and 5 from general EDs. Four major themes were found (Table). Participants described the disconnect between desired and available resources for care provision, particularly in general EDs, and consequences of this mismatch including a lower quality of care for patients and the emotional toll on providers while caring for youth with violent injuries. Participants illuminated how the intersection of personal beliefs, policy environment, and societal norms affected provider attitudes and behaviors, often manifesting as additional barriers to care. Participants also identified the role of the ED in the care continuum, including what prevention and intervention efforts they felt could and should take place in the ED. Lastly, participants provided recommendations for future resources to enhance comprehensive care provision for youth with violent injuries.

Conclusion: Pediatric and general EDs face many challenges when caring for youth with violent injuries with particular emphasis on the mismatch between needs and resources and the influence of personal beliefs and societal norms on ED care provision. Together, these themes demonstrate the collective impact of provider-, hospital-, community- and society-level factors on comprehensive care for violently injured youth in the ED and the potential downstream consequences on outcomes for youth, families and providers (Figure). EDs and hospitals seeking to improve facets of comprehensive care for violently injured youth may consider increasing pediatric-specific personnel and trainings, improving provider wellbeing initiatives, implementing or expanding collaborations with community-based organizations, and advocating for policy and systems-level changes to increase access to specialized pediatric care in their region.