Related Experiment Video
Updated: Sep 7, 2025
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Establishing national stakeholder priorities for quality improvement in pediatric trauma care: Consensus results
Caroline G Melhado1, Brian K Yorkgitis, Bhavin Patel
1From the Division of Pediatric Surgery (C.G. Melhado, A.R.J.), UCSF Benioff Children's Hospital Oakland, Oakland, California; Department of Surgery (C.G. Melhado, A.R.J.), University of California San Francisco, San Francisco, California; Department of Surgery (B.K.Y.), University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; American College of Surgeons Committee on Trauma (B.P.), Chicago, Illinois; Department of Pediatrics (K.R.), Dell Medical School at the University of Texas at Austin, Austin, Texas; Department of Surgery and Perioperative Medicine (K.R.), Dell Medical School at the University of Texas at Austin, Austin, Texas; Division of Pediatric Emergency Medicine (C.G. Macias), University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio; College of Medicine (C.G. Macias, M.W.D.), Case Western Reserve University, Cleveland, Ohio; Division of Pediatric Surgery (M.W.D.), Rainbow Babies and Children's Hospital, Cleveland, Ohio; and Emergency Medical Services for Children Innovation and Improvement Center (L.G.), University of Texas at Austin, Austin, Texas.
Insights
Quality improvement for pediatric trauma care needs national focus. Key priorities include standardized triage, improved non-pediatric center stabilization, provider training, and best-practice imaging guidelines for injured children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Quality Improvement Science
Background:
- Pediatric trauma care quality improvement efforts are concentrated in Pediatric Trauma Centers (PTCs).
- Most children do not receive initial trauma care at PTCs, leading to access disparities.
- There's a need to identify and address unmet needs in pediatric emergency care systems nationwide.
Purpose of the Study:
- To identify unmet needs for injured children within the broader pediatric emergency care system.
- To establish national priorities for quality improvement across the entire spectrum of pediatric trauma care.
Main Methods:
- A diverse panel of 10 national stakeholder organizations was convened.
- Potential quality improvement targets were identified through stakeholder meetings and surveys.
- A modified Delphi approach with four ranking iterations was used to achieve consensus on priorities.
Main Results:
- Nineteen potential quality improvement themes were identified.
- Four national priorities were established: (1) pediatric trauma triage/recognition toolkit and training, (2) minimum standards for non-PTC stabilization, (3) development of pediatric trauma champions, and (4) best-practice imaging guidelines.
- Consensus required 75% of the panel to rank an item as a top-four priority.
Conclusions:
- System-level quality improvement should prioritize minimum pediatric standards for injury care.
- Essential focus areas include frontline provider training, stabilization protocols, imaging guidelines, and local pediatric champions.
- Implementing these priorities can help reduce disparities and improve outcomes for injured children.
Background:
Quality improvement efforts within pediatric trauma centers (PTCs) are robust, but the majority of children do not receive initial postinjury care at PTCs. Disparities in access to quality trauma care remain, particularly for children who initially access the trauma system outside of a PTC. The purpose of this project was to identify unmet needs for injured children within the pediatric emergency care system and to determine national priorities for quality improvement across the continuum of pediatric trauma care.
Methods:
A panel of delegates representing patients and families, prehospital providers, federal funding partners, nurses, and physicians was recruited from 10 national stakeholder organizations. Potential targets were identified using an initial stakeholder meeting followed by a free text response survey. Free text items were coded and condensed as themes and then ranked by the panel using a modified Delphi approach to determine consensus priorities. Items not achieving >35% prioritization on a given iteration were dropped from subsequent iterations. Consensus was defined as 75% of members designating an item as a top-four priority.
Results:
Nineteen themes were identified as potential targets for QI initiatives. Four iterations of panel ranking were used to achieve consensus, with four priorities identified: (1) creation of a toolkit and standard provider training for pediatric trauma triage, shock recognition, and early recognition for need to transfer to higher level of care; (2) development of minimum standards for pediatric trauma resuscitation and stabilization capability in nonpediatric centers; (3) facilitating creation of local nursing and physician champions for pediatric trauma; and (4) development and dissemination of best-practice guidelines to improve imaging practices for injured children.
Conclusion:
System-level quality improvement priorities for pediatric trauma care should focus resources on developing and implementing minimum pediatric standards for injury care, frontline provider training, stabilization protocols, imaging guidelines, and local pediatric champions.
Level Of Evidence:
Therapeutic/Care Management; Level IV.
More Related Videos
14:43A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
09:52Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Related Concept Videos
01:20Acute Kidney Injury V: Interprofessional Care
01:30Ethical Dilemmas II
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:26Aneurysm III: Interprofessional Care