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Transferring Injured Children from Community Hospitals to a Pediatric Trauma Center: A Qualitative Study of Providers' Experiences and Ideas for Process Improvement
Alana Rosenberg, MS, Shelli Fede,r APRN/PHD-C, Karl Minges, MPH, Beth Emerson, MD, John Giuliano, MD, Marc Auerbach, MD, Pina Violano PHD, RN. Yale New Haven Hospital, New Haven, CT, USA.

Background: Many injured children present to general hospitals and require transfer to a pediatric trauma center. The transfer process involves a providers from the sending hospital, transport team and receiving hospital. The purpose of this study was to explore 1) providers' experiences with and perspectives on the transfer process and 2) providers' proposed strategies to improve this process.

Methods: This qualitative study involved 26 semi-structured interviews with providers from six community hospitals and a single pediatric trauma center. Participants included nurses, physicians, transport providers, and administrators. Interviews were conducted by a research nurse until theoretical saturation was achieved. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes.

Results: The transfer process was perceived as stressful and necessitating collaboration across professions (MD, RN, EMS) and disciplines (trauma, ED, PICU) from the sending institution, the transport team, and the trauma center (Process Map Figure). Five themes were identified as areas to improve this process: 1) Creation of a unified standard operating procedure for transfers that is applicable across institutions/teams. 2) Enhancing "shared sense making" of all providers (awareness, understanding, and agreement of a patient's clinical status, interventions needed, and plan of care). 3) Improving provider confidence, knowledge, and experience in caring for injured children. 4) Addressing organization and environmental factors that impede or delay transfer. 5) Fostering institutional and personal relationships.

Conclusions: Efforts to improve the pediatric trauma transfer process should include creating standard operating procedures, enhancing communication, improving knowledge, addressing systems factors and fostering relationships.

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