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Pediatric Rapid Response Nurse Deployment to Pediatric Trauma Activations: A Process Improvement Initiative
Lori N Moss1, Aaron J Cunningham, Joseph Tobias
1OHSU Doernbecher Children's Hospital, Portland, Oregon.
Insights
Deploying pediatric rapid response nurses to trauma activations significantly reduced emergency department length of stay for critically injured children. This quality improvement initiative enhances patient care and streamlines transfers to the pediatric intensive care unit.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Quality improvement initiatives
Background:
- Prolonged emergency department (ED) length of stay (LOS) in trauma patients increases mortality.
- Pediatric trauma patients have limited physiologic reserve, making early decompensation a concern.
- Subtle warning signs in injured children can precede critical deterioration.
Purpose of the Study:
- To evaluate the impact of pediatric rapid response nurses on ED LOS for pediatric trauma activations.
- To assess the effect of this intervention on patient transfer to the pediatric intensive care unit (PICU).
Main Methods:
- A before-and-after analysis of a quality improvement project.
- Involved deploying pediatric rapid response nurses during full trauma activations.
- Utilized trauma registry data from January 2016 to August 2020.
- Statistical analysis included unpaired t tests and chi-squared analysis.
Main Results:
- 94 pediatric trauma patients meeting inclusion criteria were analyzed.
- The post-intervention group (n=34) showed a reduced median ED LOS (36.5 min) compared to the pre-intervention group (n=60, 48.5 min).
- The difference in ED LOS was statistically significant (p = .019).
Conclusions:
- Implementing pediatric rapid response nurses in trauma activations improves patient assessment and transfer.
- This initiative effectively decreases emergency department length of stay for pediatric trauma patients.
- Facilitates timely transition to the pediatric intensive care unit.
Background:
Prolonged emergency department length of stay in trauma patients is associated with increased hospital length of stay and inhospital mortality. This problem is compounded in pediatric patients, as injured children have less physiologic reserve and may exhibit only subtle warning signs before decompensation.
Objective:
To determine the impact of deploying pediatric rapid response nurses to full trauma activations for patients transferred to the pediatric intensive care unit on emergency department length of stay.
Methods:
This is a before-and-after analysis of a quality improvement initiative deploying pediatric rapid response nurses to full trauma activations. Trauma registry data collected from January 2016 to August 2020 were statistically analyzed. Demographic and outcome variables were assessed by unpaired t test and χ2 analysis.
Results:
A total of 94 patients met inclusion criteria as full activations admitted to the intensive care unit during the study period. The preimplementation group (n = 60) was 88% (n = 53) male, with a median age of 6.9 years and a median Injury Severity Score of 21. The postimplementation group (n = 34) was 62% (n = 21) male, with a median age of 5.6 years and a median Injury Severity Score of 17. The emergency department length of stay decreased from median (interquartile range) 48.5 (36.0-84.75) min (preimplementation) to 36.5 (27.5-55.5) min (postimplementation; p = .019).
Conclusion:
Deployment of pediatric rapid response nurses to full trauma activations facilitates the assessment and transfer of pediatric trauma to the intensive care unit and decreases emergency department length of stay.
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