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Moving Towards Standardized Pediatric Performance Improvement Measures In Non-accidental Trauma: A Modified Delphi Approach
*Todd Nickoles1, *Jodie Greenberg1, *LeAnne Young2, *Amy Randall3, *Michele Herndon4, *Maria Bautista-Durand5, *Linda Roney6, *Maria McMahon7
1Phoenix Children's Hospital, Phoenix, AZ;2Joe DiMaggio Children's Hospital, Hollywood, FL;3C. S. Mott Children's Hospital, Ann Arbor, MI;4St. Louis Children's Hospital, St. Louis, MO;5Children's Hospital Los Angeles, Los Angeles, CA;6Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT;7Boston Children's Hospital, Boston, MA

Background (issue):
There is limited guidance for pediatric trauma centers (PTC) regarding best practice for measuring and reviewing performance improvement (PI) in the non-accidental trauma (NAT) population. In an effort to move PTC programs toward standardized guidelines and PI practices for NAT, we assessed current practice and points of consensus among level 1 and 2 PTCs across the United States.
Methods:
We conducted electronic surveys distributed to pediatric trauma program managers representing 128 PTCs. The surveys collected information on trauma center demographics, coding practices, definitions, current PI measures, prevention programs, and opinions regarding key components of NAT guidelines. Surveys were distributed in rounds according to a modified Delphi methodology.
Findings:
We received responses from 90 (70%) of PTCs [47 (84%) ACS verified level 1 PTCs; 29 (69%) ACS verified level 2 PTCs; and 14 (47%) state PTCs]. Of the respondents, 88% agreed that establishing a national consensus for NAT PI is important and 93% thought their institution would benefit from standardized NAT guidelines. Although the PI process varied among PTCs in terms of measures, review, and coding practices, we were able to achieve several points of consensus through the modified Delphi process.
Conclusions (implications for practice):
Survey results demonstrate areas of consistency and a foundation for consensus among PTCs. Results also identify areas of practice diversity that may benefit from an attempt to standardize PI across centers. To that end, we have utilized the Delphi process to inform a series of statements regarding PI best practices for NAT.


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