Complexity of the pediatric trauma care process: Implications for multi-level awareness

Area of Science:

• Healthcare systems engineering
• Patient safety research
• Pediatric trauma care

Background:

• Trauma is a leading cause of death and disability in young people in the US.
• Existing research on pediatric trauma care primarily focuses on medical aspects, with limited understanding of in-hospital processes and team dynamics.

Purpose of the Study:

• To describe the processes and roles within pediatric inpatient trauma care using human factors engineering (HFE) methods.
• To analyze the complexity of intra-hospital care transitions and their impact on patient safety.
• To propose strategies for managing complexity and enhancing resilience in pediatric trauma care.

Main Methods:

• Utilized human factors engineering (HFE) methodologies.
• Combined data from interviews, archival documents, and trauma registries.
• Identified patient care roles, inter-unit transitions, and unique care pathways for pediatric trauma patients.

Main Results:

• Identified 53 distinct roles involved in pediatric trauma patient care.
• Documented 3324 total transitions between hospital units and 69 unique patient pathways.
• Highlighted the complexity arising from numerous roles and transitions in pediatric trauma care.

Conclusions:

• Advocates for shifting focus from eliminating complexity to managing it within healthcare systems.
• Proposes enhancing patient safety through three levels of awareness: individual, team, and organizational.
• Suggests sociotechnical solutions, including clinical decision support and simulation-based training, to address challenges in awareness and improve adaptation in complex care environments.