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The Status of Quality Improvement Programs for Pediatric Traumatic Brain Injury Care in Argentina
Silvia Lujan1, Gustavo Petroni1, Pablo Castellani2
1Centro de Informática e Investigación Clínica (CIIC), Rosario, Sante Fe, Argentina.
Insights
Quality improvement programs for pediatric traumatic brain injury (TBI) are present in Argentine hospitals, with most having guidelines and case discussions. Opportunities exist to improve data adequacy and documentation, especially in smaller facilities.
Area of Science:
- Pediatric Traumatology
- Public Health
- Healthcare Quality Improvement
Background:
- Trauma quality improvement (QI) programs are vital for enhancing patient care and outcomes.
- Data on QI programs specifically for pediatric traumatic brain injury (TBI) in Latin America are limited.
Purpose of the Study:
- To assess the current status of QI programs and activities for pediatric TBI in Argentine hospitals.
- To identify variations in QI practices based on hospital characteristics.
Main Methods:
- A survey was conducted in 2019 across 15 Argentine hospitals, collecting data on hospital characteristics, QI practices, registries, and TBI care protocols.
- Statistical comparison (Fisher's exact test) was used to evaluate differences in QI activities between hospital types.
Main Results:
- All hospitals had guidelines for pediatric TBI care, focusing on intracranial pressure management and infection prevention.
- Morbidity and mortality meetings discussing pediatric TBI care occurred regularly in most hospitals (53% weekly-monthly).
- Larger hospitals demonstrated better data adequacy for case reviews (88%) compared to smaller ones (29%, P=0.046), with 53% utilizing computerized trauma registries.
Conclusions:
- While most Argentine hospitals have established guidelines and case discussion forums for pediatric TBI, improvements are needed in documentation and data adequacy for case reviews.
- Enhancing data collection, particularly in smaller hospitals, and increasing the use of computerized trauma registries are recommended.
- These improvements can further optimize the quality of care for pediatric TBI patients.
Introduction:
Trauma quality improvement (QI) programs improve care and outcomes for injured patients. Information about QI programs for pediatric traumatic brain injury (TBI) is sparse in Latin America.
Methods:
We gathered data on the status of QI programs and activities that encompass pediatric TBI at 15 Argentine hospitals. Data were gathered during 2019 and included hospital characteristics, QI practices, presence of a queryable registry, and use of protocols for TBI care. Level of QI activities was compared between hospital types using Fisher's exact test.
Results:
Most hospitals had guidelines for pediatric TBI care, including management and/or prevention of intracranial pressure (100%) and central-line-associated infections (87%). Morbidity and mortality meetings or other types of case discussions in which quality of pediatric TBI care was discussed were held by all hospitals, with most (53%) having weekly-monthly meetings, but 27% having rare or annual meetings. Sixty percent of hospitals had adequate data for case reviews (fewer than 25% of cases with essential information missing). Fifty-three percent documented discussions that occurred at these meetings and 53% utilized computerized trauma registries. Larger hospitals (> 200 beds) more frequently had adequate data (88%) for case reviews than smaller hospitals (29%, P = 0.046). Hospital size did not affect other QI activities.
Conclusions:
Most hospitals had guidelines for pediatric TBI care. Adequacy of care was discussed at reasonably frequent case conferences. Opportunities for improvement include increasing documentation of case reviews and improving adequacy of data for case reviews, especially at smaller hospitals. Greater use of computerized trauma registries could provide such data.
