Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement...

Area of Science:

• Pediatric critical care medicine
• Quality improvement science
• Trauma patient management

Background:

• Efficient transfer of adult trauma patients to the intensive care unit (ICU) improves outcomes and reduces emergency department (ED) length of stay (LOS).
• Quality improvement (QI) initiatives for rapid pediatric trauma patient transfer to the pediatric ICU (PICU) are less studied.
• This study addresses the need for QI in pediatric trauma patient ED-to-PICU transfer processes.

Purpose of the Study:

• To evaluate the impact of institutional system changes on expediting pediatric trauma patient transfer to the PICU.
• To assess the effect of mandatory PICU team involvement on ED length of stay (ED LOS) for pediatric trauma patients.

Main Methods:

• A quality improvement initiative using the plan-do-study-act (PDSA) framework, commencing in 2013.
• Collected preliminary ED LOS data for pediatric trauma patients (pre-implementation cohort: 2012).
• Implemented mandatory attendance of the PICU charge nurse and attending physician for highest-level pediatric trauma activations in subsequent PDSA cycles.

Main Results:

• Analyzed 151 pediatric trauma patients admitted to the PICU from 2012-2019.
• Observed a median decrease in ED LOS of 105 minutes post-implementation.
• Demonstrated a reduction in median ED LOS and variation with each PDSA cycle.

Conclusions:

• Inclusion of PICU charge nurse and attending physician in pediatric trauma activations expedited PICU access.
• System changes effectively decreased ED LOS for pediatric trauma patients.
• QI initiatives can optimize critical care pathways for pediatric trauma survivors.