<p><strong>OBJECTIVE: </strong>Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved.</p>

<p><strong>METHODS: </strong>We performed semistructured interviews with parents and PEM physicians at a single academic, children's hospital. English-speaking parents were selected utilizing a standard definition of CMC during an ED visit in which their child was admitted to the hospital. All PEM physicians were eligible. We developed separate interview guides utilizing open-ended questions. The trained study team developed and modified a coding tree through an iterative process, double-coded transcripts, monitored inter-rater reliability to ensure adherence, and performed thematic analysis.</p>

<p><strong>RESULTS: </strong>Twenty interviews of parents of CMC and 16 of PEM physicians were necessary for saturation. Parents identified specific challenges related to ED care of their children involving time, information gathering, logistics/convenience, and multifaceted communication between health teams and parents. PEM physicians identified time, data accessibility and availability, and communication as inter-related challenges in caring for CMC in the ED. Suggestions reflected potential solutions to the challenges identified.</p>

<p><strong>CONCLUSIONS: </strong>Time, data, and communication challenges were the main focus for both parents and PEM physicians, and suggestions mirrored these challenges. Further research and quality improvement efforts to better characterize and mitigate the identified challenges could be of value for this vulnerable population.</p>

<p>Children with medical complexity (CMC) are traditionally defined as those who have health conditions that are expected to last at least 12 months and affect multiple body systems or 1 system severely enough that specialty care and hospitalization are necessary. This definition has been refined recently to reflect the necessary multifaceted approach to address increasing prevalence, cost, and challenges of caring for this population in the community and the hospital setting. Most of the current literature on CMC focuses specifically on the strengthening of the medical home (and more recently, the medical neighborhood) and highlights the importance of preventing inpatient hospitalization and emergency care. The importance of this work is irrefutable for CMC, but in regard to their emergency needs, we would like to propose a flip in the current script.</p>