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A management model for admission and treatment of pediatric trauma cases
Raya Tashlizky Madar1, Avishay Goldberg2,3, Nitza Newman4
1Nursing Academy, Barzilai University Medical Center, Ashkelon, Israel. rayat@bmc.gov.il.
Insights
Developing a management model using the Theory of Constraints (TOC) improved pediatric trauma care by addressing facility and training gaps. This model ensures optimal treatment for severely injured children.
Area of Science:
- Pediatric Trauma Care
- Healthcare Management
- Systems Engineering
Background:
- Major pediatric trauma cases often receive suboptimal care in facilities lacking specialized training.
- There's a critical need for improved management strategies for severely injured children.
Purpose of the Study:
- To develop a management model for the admission and treatment of pediatric trauma.
- Utilize the Theory of Constraints (TOC) to optimize pediatric trauma care pathways.
Main Methods:
- Qualitative analysis of interviews with 17 policy makers and managers in pediatrics and trauma.
- Application of TOC to identify undesirable effects and core challenges.
- Construction of a focused current reality tree (CRT) and a subsequent management model.
Main Results:
- Identified 4 key undesirable effects: lack of clear case manager definitions, uniform admission site criteria, standard treatment/training guidelines, and evacuation protocols.
- The management model focuses on human resources, hospital policy for emergency departments (EDs), and clear definitions of pediatric trauma levels.
Conclusions:
- Optimal pediatric trauma EDs require operating rooms, ICU beds, imaging, labs, child-appropriate equipment, and trained staff.
- Medical centers should be classified by trauma capabilities to ensure optimal outcomes for pediatric trauma patients.
Background:
Pediatric trauma, particularly major trauma cases, are often treated in less than optimal facilities by providers who lack training and experience in treating severely injured children. We aimed to develop a management model for admission and treatment of pediatric trauma using the Theory of Constraints (TOC).
Methods:
We conducted interviews with 17 highly experienced policy makers, senior nursing managers and medical managers in pediatrics and trauma. The interviews were analyzed by qualitative methods. The TOC was utilized to identify undesirable effects (UDEs) and core challenges, and to design a focused current reality tree (CRT). Subsequently, a management model for optimal admission and treatment of pediatric trauma was constructed.
Results:
The CRT was illustrated according to 4 identified UDEs focusing on lack of: (1) clear definitions of case manager in pediatric trauma; (2) uniform criteria regarding the appropriate site for admitting pediatric trauma, (3) standard guidelines and protocols for treatment of trauma cases and for training of trauma medical teams; and (4) standard guidelines for evacuating pediatric trauma patients. The management model for treatment and admission of pediatric trauma is based on 3 major elements: human resources, hospital policy concerning the appropriate emergency department (ED) for pediatric trauma patients and clear definitions regarding children and trauma levels. Each of the elements contains components that should be clearly defined in order for a medical center to be designated for admitting and treating pediatric trauma patients.
Conclusions:
Our analysis suggests that the optimal ED for pediatric trauma cases is one with available operating rooms, intensive care beds, an imaging unit, laboratories and equipment suitable for treating children as well as with staff trained to treat children with trauma. To achieve optimal outcomes, medical centers in Israel should be classified according to their trauma treatment capabilities and their ability to treat varied severities of pediatric trauma cases.
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