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Using a Multidisciplinary and Evidenced-Based Approach to Decrease Under Triage of Pediatric Trauma Patients
Mauricio A. Escobar, Jr., MD and Carolynn Morris, MN, RN, Mary Bridge Children's Hospital, Tacoma WA

BACKGROUND The American College of Surgeons Committee on Trauma (ACS-COT) view over- and under-triage rates based on trauma team activation (TTA) criteria as surrogate markers for quality trauma patient care. Under-triage occurs when classifying patients as not needing a TTA when they do. Over-triage occurs when a TTA is unnecessarily activated. ACS-COT recommends under-triage < 5% and over-triage ? 50%. We sought to improve the under-triage and over-triage rates at our Level II Pediatric Trauma Center by (1) improving accuracy in following established Trauma Team Activation Criteria, (2) modifying established Trauma Team Activation Criteria in an evidence-based fashion to better identify severely injured children, (3) analyze the financial impact of standardization. METHODS This study was designed prospectively as a Process Improvement Patient Safety (PIPS) project. Data was obtained from our Trauma Registry: (1) 2011 YTD data was used as a Baseline; (2) Phase I (Q1 2012) of the study involved using TTA Criteria. The Base Station form was revised to reflect key components of TTA Criteria. (3) Phase II (Q2 2012) of the study moved the Trauma Team Activation responsibility primarily to nursing (collaborating with MDs) and adding Box D regarding transfers-in from outside hospitals. RESULTS Phase I demonstrated accuracy of our TTA Criteria. Phase II demonstrated an under-triage rate of 4.6% (12/259 pts) and over-triage rate of 53% (7/13). Performance was sustained by hardwiring a standardized process. Under-triage QTR 1 2014 was 3.8% and over-triage 0%. Finally, this PIPS project had a positive effect on charge capture. A comparison between 2011 Qtr 3 YTD and 2012 Qtr 3 YTD shows a charge capture (Trauma Team Activation charges) increase of \,136,264 (72.3%). CONCLUSIONS Standardization of process resulted in improved, sustainable under-/over-triage rates. Our financial performance improved by closing the gap between 15% under-triage baseline and 5% under-triage ACS standard.
Utilizing a Process Improvement Process (PIP) to power standardization results in improved, sustainable under-/over-triage rates. Back to 2nd Annual Meeting Program