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Optimizing Pediatric Trauma Imaging Interpretation Timeliness: A Multicenter Quality Improvement Study
Ashley N Urban1, Carleen Schneiter, Addison Liska
1Author Affiliations: Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado (Drs Maloney, Meyers, Milla, and Monson); Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, Colorado (Drs Maloney, Meyers, Monson, and Milla, Mss Bushur, and LeBlanc); Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado (Mss Urban, Martin, Koehler, and Dr Acker); Division of Pediatric Surgery, Children's Hospital Colorado, Colorado Springs, Colorado (Mr Culbertson); Department of Critical Care, Children's Hospital Colorado, Aurora, Colorado (Dr Schneiter); Section of Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado (Drs Anstett, Kim and Ms Liska); Department of Process Improvement, Children's Hospital Colorado, Aurora, Colorado (Ms English); and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado (Drs Anstett, Schneiter, Kim, and Acker, Mr Culbertson, and Ms Koehler).
Insights
Implementing a streamlined imaging protocol significantly reduced interpretation times for pediatric trauma patients, improving care consistency without compromising quality. This enhances emergency response for injured children.
Area of Science:
- Pediatric Emergency Medicine
- Radiology Quality Improvement
- Trauma Care Protocols
Background:
- Imaging interpretations for pediatric trauma patients vary significantly, impacting care in over 50% of cases.
- Delayed radiology interpretation in pediatric trauma leads to longer emergency department stays and missed injuries.
- Lack of standardized imaging protocols hinders timely interpretation for severely injured pediatric patients.
Purpose of the Study:
- To evaluate the impact of a streamlined imaging protocol on the timeliness and consistency of image interpretation.
- To assess changes in pediatric trauma patient care following protocol implementation.
Main Methods:
- A pre- and post-intervention quality improvement study was conducted at Level I and II Pediatric Trauma Centers.
- Included pediatric patients (≤18 years) meeting trauma activation criteria from referring facilities.
- Measured image interpretation timeliness and consistency using statistical process control charts.
Main Results:
- Median interpretation time decreased from 145 to 51 minutes post-protocol.
- Variability in interpretation times significantly reduced (SD decreased from 680 to 170 minutes).
- No missed injuries affecting patient care were identified before or after the intervention.
Conclusions:
- A streamlined imaging protocol enhances the speed and consistency of image interpretation for pediatric trauma patients.
- The protocol improved efficiency without negatively impacting the quality of care or patient safety.
Background:
Imaging interpretations for pediatric trauma patients transferred from general emergency departments to pediatric hospitals differ in up to 40% of cases, with more than half affecting patient care. Delays in radiology image interpretation lead to extended emergency department stays, unnecessary reimaging, and delayed injury recognition. Currently, no streamlined imaging protocol exists to ensure timely image interpretation for severely injured pediatric patients.
Objective:
To assess improvements in timeliness and consistency of imaging interpretation before and after implementation of a streamlined protocol for severely injured pediatric trauma patients.
Methods:
A quality improvement pre- and post-intervention study was conducted at Level I and Level II Pediatric Trauma Centers located in the western United States from April 2023 to December 2024. Pediatric patients aged 18 and younger who met the institutional trauma activation criteria and came from a referring facility with images were included in the study. Outcomes included image interpretation timeliness and consistency (measured by variability in interpretation times and sustained process change via statistical process control charts).
Results:
There were 86 patients meeting criteria during the study. After implementation, the median time to image interpretation decreased from 145 to 51 min, and variability in interpretation times decreased (standard deviation decreased from 680 to 170 min). No missed injuries that changed patient care were observed before or after the intervention.
Conclusion:
Implementation of a streamlined imaging protocol for pediatric trauma patients led to faster and more consistent image interpretation without compromising care quality.
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