Voices From the Community: How Inpatient Clinicians Experience Caring for Deteriorating Children

BACKGROUND: National initiatives to improve care for children in community emergency department settings have demonstrated improved quality with decreased pediatric mortality. In contrast, pediatric readiness for inpatient care in community hospitals remains poorly defined. Caring for a child whose condition deteriorates unexpectedly requires timely recognition, communication, escalation, stabilization, and transfer when needed. As such, we aimed to understand the experience of inpatient clinicians caring for clinically deteriorating children with evolving acute care needs in community hospitals. METHODS: We conducted a qualitative study, utilizing an inductive approach, from November 2023 to May 2024. Using purposive sampling, we conducted semi-structured interviews with pediatric hospitalists, nurses, and respiratory therapists from 16 community hospitals in the Northeastern United States. Data were analyzed using thematic analysis. RESULTS: Twenty-three clinicians participated. We identified 4 themes: (1) Trust-based collaborative decision-making; (2) Adaptive clinical decision-making strategies; (3) Building pediatric-specific capability; (4) The invisible labor of isolated pediatric expertise and its emotional toll. A framework linking clinician experiences to individual and hospital-level consequences was derived, and 14 components for a future pediatric inpatient readiness toolbox were identified. CONCLUSION: Community clinicians caring for deteriorating children rely on trusted relationships, ongoing decision-making under resource constraints, and locally developed preparedness systems. Future pediatric inpatient readiness frameworks should incorporate these contextual factors alongside traditional measures of staffing, equipment, medications, and clinical capability.