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Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

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Multidisciplinary approach to decrease pediatric trauma undertriage.

Benjamin Eithun¹, Ankush Gosain²

¹Pediatric Trauma Program, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.

The Journal of Surgical Research

|September 25, 2016

Summary

This summary is machine-generated.

Improving pediatric trauma care, this study enhanced trauma activation criteria. Shifting leveling to nurses and revising criteria reduced undertriage to 5.3% and overtriage to 18.2%, ensuring accurate patient identification and resource allocation.

Keywords:

Activation Leveling Pediatric Trauma Triage

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Area of Science:

Pediatric Trauma Care
Process Improvement in Healthcare
Emergency Medicine

Background:

Trauma activation and leveling criteria aim to balance undertriage (UT) and overtriage (OT) risks.
American College of Surgeons (ACS) guidelines recommend UT ≤5% and OT 25%-50%.
Intervention focused on improving accuracy and modifying criteria for identifying severely injured children.

Purpose of the Study:

To enhance the accuracy of trauma leveling and activation criteria in a pediatric trauma center.
To reduce undertriage (UT) and overtriage (OT) rates.
To ensure sustainable improvements in pediatric trauma patient identification and resource utilization.

Main Methods:

Prospective, interventional process improvement study at an ACS-verified level I pediatric trauma center.
Phase I: Shifted trauma leveling responsibility from physicians to nursing care team leaders.
Phase II: Implemented revised, evidence-based activation criteria; sustainability assessed in 2014.

Main Results:

Phase I: Improved accuracy from 70% to 99%; UT decreased from 10% to 8%; OT decreased from 37.5% to 33.3%.
Phase II: UT further decreased to 5.1%; OT increased to 40%.
Sustainability (2014): UT at 5.3%, OT at 18.2%; adherence to criteria remained high (95%).

Conclusions:

Transferring trauma leveling to nursing staff significantly improved accuracy.
Revised activation criteria, incorporating CDC and ACS guidelines and tailored to the population, sustainably reduced UT.
The interventions effectively optimized the balance between identifying severe injuries and efficient resource allocation.