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A Handoff Protocol for Pediatric Trauma Patients at a Rural Level One Trauma Center Reduces Length of Stay
Evelyn Coile1, Kathryn Bailey, Eric J Clayton2
1Memorial Health University Medical Center, Savannah, GA, USA.
Insights
Implementing a 24-hour handoff protocol for pediatric trauma patients from adult to pediatric surgeons significantly reduced hospital length of stay. This streamlined care improved efficiency for pediatric trauma management.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Healthcare Management
Background:
- Pediatric trauma patient management varies across trauma centers.
- Some centers transfer care post-resuscitation, while others maintain surgeon control.
- A hypothesis proposed that surgeon handoff improves care coordination and reduces length of stay.
Purpose of the Study:
- To evaluate the impact of a standardized handoff protocol on pediatric trauma patient length of stay.
- To assess if transferring care to pediatric surgeons within 24 hours improves outcomes.
- To analyze the effect of handoff on emergency department disposition and post-ED acuity.
Main Methods:
- Retrospective review of 1267 pediatric trauma patient charts (Oct 2014-Oct 2018).
- Analysis of length of stay before and after implementing a surgeon handoff protocol.
- Inclusion of all demographics, trauma triage levels, and post-ED dispositions.
Main Results:
- Mean length of stay was reduced by 0.38 days (P < .0005).
- This reduction was observed across all demographics, trauma triage levels, and injury mechanisms.
- The handoff protocol positively impacted length of stay regardless of post-ED disposition acuity.
Conclusions:
- A 24-hour handoff protocol from adult to pediatric surgeons significantly reduces length of stay for pediatric trauma patients.
- The protocol enhances care coordination, leading to more efficient management.
- This standardized approach benefits all pediatric trauma patient demographics and injury types.
Background:
The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff.
Methods:
A retrospective review from October 2014 to October 2018 was conducted at our rural level 1 trauma center analyzing the length of stay across all demographics and trauma triage levels before and after institution of a handoff protocol from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window. Further analysis included emergency department (ED) disposition to include the effect of handoff on the length of stay in the setting of a higher post-ED acuity, that is, disposition of monitored beds.
Results:
1267 patient charts were analyzed and the mean length of stay was reduced by .38 days (t = 5.92, P < .0005) across all demographics, trauma triage levels, post-ED dispositions, and mechanisms of injury after institution of our handoff protocol.
Conclusion:
Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 (t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.
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