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Using a multidisciplinary and evidence-based approach to decrease undertriage and overtriage of pediatric trauma

Mauricio A Escobar¹, Carolynn J Morris¹

¹Mary Bridge Children's, Tacoma, WA.

Journal of Pediatric Surgery

|May 10, 2016

Summary

This summary is machine-generated.

Improving trauma team activation (TTA) criteria in pediatric trauma care significantly reduced undertriage to 5%, meeting American College of Surgeons Committee on Trauma standards. This enhanced patient identification and resource allocation.

Keywords:

Pediatric trauma Process improvement Trauma triage

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Area of Science:

Trauma Surgery
Pediatric Emergency Medicine
Quality Improvement

Background:

The American College of Surgeons Committee on Trauma (ACS-COT) uses undertriage and overtriage rates as quality indicators for trauma patient care.
Current ACS-COT recommendations suggest undertriage rates below 5% and overtriage rates between 25-35%.
This study addresses outdated trauma team activation (TTA) criteria at a Level II Pediatric Trauma Center to improve patient identification and resource utilization.

Purpose of the Study:

To enhance the accuracy of trauma patient identification by revising TTA criteria.
To decrease undertriage and overtriage rates in a pediatric trauma population.
To improve adherence to evidence-based TTA criteria for better patient outcomes.

Main Methods:

A prospective Process Improvement Patient Safety (PIPS) project conducted in two phases.
Phase I focused on revising TTA criteria and improving adherence using a modified Base Station report.
Phase II shifted TTA responsibility to nursing staff, incorporating inter-facility transfer criteria, and calculated triage rates using the Cribari method.

Main Results:

Baseline undertriage was 15% and overtriage was 75%.
Following revised TTA criteria and improved adherence, undertriage decreased to 4.7% and overtriage fluctuated between 20% and 54%.
Appropriate triage correlated with appropriate resource utilization, with shifts in patient disposition from the ER to the OR, PICU, or Med-Surg.

Conclusions:

Standardizing TTA processes led to improved and sustainable undertriage and overtriage rates, meeting ACS-COT standards for undertriage.
Evidence-based TTA criteria and process standardization are crucial for accurate pediatric trauma patient identification.
Appropriate triage decisions positively impact the efficient utilization of trauma center resources.