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Trauma Nurse Clinician Impact on Quality Metrics at a Pediatric Level 1 Trauma Center
Charlotte E. Yarrow, RN, BSN 1, Susanne K. Hanada, RN, BSN1, Kellie J. Rowker, RN, BSN1, Karen S. Hill, RN, BSN1, Matthew T. Santore, MD1,2, Amina M. Bhatia, MD, MS 1,2. 1Children's Healthcare of Atlanta, Atlanta, GA, USA, 2Emory University School of Medicine, Atlanta, GA, USA.

Background: Physician extenders are being increasingly used at trauma centers to administer care traditionally performed by surgical residents. Our aim is to determine impact of trauma nurse clinicians (TNC) on the delivery of trauma care at a pediatric, level 1 trauma hospital.

Methods: Five quality indicators (QI) (transfer to PICU ≤3 hours, transfer to CT scan in ≤30 minutes, analgesia administration ≤30 minutes, avoidance of hypothermia, documentation of end tidal CO2 every 30 minutes) were prospectively collected after 987 trauma activations from 2012-2015. Achievement of QI were compared by TNC presence or absence in the trauma activation using Cochran-Mantel-Haenszel statistic, controlling for calendar year. Prospectively collected records of injuries identified on tertiary surveys by the TNC were recorded in 2015.

Results: The presence of a TNC was associated with a significant increase in the achievement of 3/5 QI (transfer to CT scan in ≤30 minutes: 95.71% vs. 85.78%, p=0.0024; avoidance of hypothermia: 95.30% vs. 90.05%, p=0.0098; documentation of end tidal CO2 every 30 min: 81.68% vs. 67.39%, p=0.0068) and with a trend toward achievement of all indicators (85.59% vs. 80.80%, p=0.0787). In 2015, 649 tertiary surveys were performed by TNC. Additional injuries, abnormalities or inadequate tetanus status were identified in 49 (3.54%) with orthopedic injuries being the most frequent delayed injury identified (14/49, 32.56%).

Conclusions: TNC help to meet trauma performance goals and are a valuable addition to the pediatric trauma team, improving quality of care for children both in the emergency department and after admission.

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