Impact of Adult Level 1 Trauma Designation on the Timeliness of Pediatric Emergency Department CT Scans
Onyinyechi Ukwuoma, MD, MPH1; Michael Dingeldein, MD2; Leslie Dingeldein, MD1
1Rainbow Babies and Children's Hospital, Cleveland, OH; 2UH Rainbow Babies and Children's Hospital, Cleveland, OH
BACKGROUND-Timeliness is an essential aspect of patient safety and healthcare quality. The adult emergency department (ED) of our institution was verified as a Level1 Trauma Center in December 2015, twenty-four years after our pediatric ED was recognized as a Level1 Trauma Center. A single computed tomography(CT) scanner in our ED is utilized by both the adult and pediatric sections. We sought to assess the impact of adult Level1 Trauma designation on the timeliness of pediatric non-trauma CT-scans.
METHODS-Retrospective chart review of pediatricED patients who had CT-scans was performed. We compared CT orders of patients prior to and after adultED Level1 Trauma verification, assessing the time from order to completion. Unpaired student t-tests and Chi-squared tests were used for statistical analyses.
RESULTS-There were 218 consecutive CT-scans analyzed in 2015, and 193 consecutive CT-scans in the same timeframe in 2016. The average time for CT completion prior to adult ED Level1 verification was 39.5minutes, compared to 55.5minutes the next year(p<0.0001). Also, the proportion of children receiving CT-scans within 60minutes from order decreased from 81% in 2015 to 65% in 2016(p=0.0002; 95% CI 7.4 – 24.4).
CONCLUSION-The new designation of adult Level1 trauma status in our ED was associated with a significant delay (by>40%) in performance of non-trauma pediatric CT-scans, and decrease in the likelihood of receiving CT-scans within 60minutes. These findings may have significant clinical and economic ramifications for pediatric patients and hospitals, and represent the potential collateral damage of an institution receiving an upgrade of adult trauma center to Level1 status.
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