Implementing the National Pediatric Readiness Project in Community Emergency Departments: A CFIR 2.0-Guided Qualitative Study of Academic Medical Center Partner Perceptions.

OBJECTIVES

The National Pediatric Readiness Project (NPRP) offers an evidence-based framework for pediatric emergency readiness, yet implementation in general emergency departments (GEDs) remains variable. The Pediatric Emergency Care Coordinator (PECC) is the central driver of NPRP operationalization. The Improving Pediatric Acute Care Through Simulation (ImPACTS) collaborative formalized the Academic Medical Center (AMC) Partner role-experienced pediatric emergency clinicians providing structured NPRP implementation support to GED PECCs. We characterized AMC Partners' perceptions of barriers and facilitators to GED NPRP implementation and how AMC Partner facilitation supports PECC operationalization across diverse community settings.

METHODS

Using the Consolidated Framework for Implementation Research (CFIR 2.0), we conducted semi-structured interviews with 23 AMC Partners (11 physicians, 12 nurses) from the 2023 ImPACTS collaborative, analyzed using hybrid thematic analysis organized by CFIR 2.0 domains.

RESULTS

Implementation determinants spanned all 5 CFIR 2.0 domains. AMC Partners described the NPRP as a legitimizing framework, with GED implementation depending on leadership engagement, protected administrative time, and relationship-based facilitation. Workforce instability, role ambiguity, and low pediatric volume were persistent barriers. AMC Partners functioned as boundary spanners, translating NPRP standards into local action through site visits, simulation-based systems testing, Pediatric Readiness Score audit and feedback, and iterative mentorship. Absence of regional AMC Partner networks was a critical gap.

CONCLUSIONS

Successful NPRP implementation requires more than PECC designation. Leadership support, protected time, and structured AMC Partner facilitation are essential. These findings inform development of regional AMC Partner network models to extend support to community, rural, frontier, and Tribal emergency departments.