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Establishing National Stakeholder Priorities For Quality Improvement In Pediatric Trauma Care: Consensus Results Using A Modified Delphi Process
*Caroline G Melhado1, *Brian K Yorkgitis2, Bhavin Patel3, Katherine Remick4, Charles G. Macias5, *Michael W. Dingeldein5, *Lisa Gray4, *Aaron R Jensen1
1University of California San Francisco, Oakland, CA;2University of Florida, Jacksonville, FL;3American College of Surgeons, Chicago, IL;4Dell Medical School at the University of Texas at Austin, Austin, TX;5Case Western Reserve University, Cleveland, OH

Background (issue): Quality improvement (QI) efforts within pediatric trauma centers are robust, but the majority of children receive initial post-injury care at hospitals not designated as pediatric trauma centers. QI needs for injured children outside of pediatric trauma centers remain unmet. The purpose of this project was to determine national priorities for quality improvement across the continuum of pediatric trauma care.
Methods: A panel of delegates representing patients and families, prehospital providers, Federal funding partners, nurses, and physicians was recruited from ten national stakeholder organizations. Potential targets were identified using an initial stakeholder meeting followed by a free text response survey. Free text items were coded and condensed as themes, and subsequently ranked by the panel using a modified Delphi approach with iterative ranking to determine consensus top four priorities. Items not achieving 20% prioritization on a given iteration were dropped from subsequent iterations of ranking. Consensus was defined as 75% of members designating an item as a top-four priority.
Findings: Nineteen themes were identified as potential targets for QI initiatives related to pediatric trauma care. Four iterations of panel ranking were utilized to achieve consensus, with four topics identified as priorities (Table).
Conclusions (implications for practice): Quality improvement priorities for pediatric trauma care should focus resources on developing and implementing minimum pediatric standards for injury care, front line provider training, stabilization protocols, imaging guidelines, and local pediatric champions.

Table 1: Consensus Rankings for National Quality Improvement Priorities in Pediatric Trauma Care
Quality Improvement ActivityRank
Median (IQR)
Top Priority
(%)
Creation of a toolkit and standard provider training for pediatric trauma triage, shock recognition, and early recognition for need to transfer to higher level of care.1 (1,2)100%
Development of minimum standards (Level 3 Peds verification/designation or 'Peds Ready' status) for pediatric trauma resuscitation and stabilization capability in non-pediatric centers.3 (2,4)90%
Facilitate creation of local nursing and physician champions for pediatric trauma care (Pediatric Emergency Care Coordinator development, engagement with adult surgeons).3 (2,4)85%
Develop and disseminate best practice guidelines for imaging (X-ray, CT, MRI) to decrease inappropriate imaging of injured children.4 (3,4)75%


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