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Reduction in Admission of Pediatric Trauma Patients to Nonsurgical Services at a Level 1 Center

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Reduction in Admission of Pediatric Trauma Patients to Nonsurgical Services at a Level 1 Center
Sabrina Thompson-Fisher, RN, MSN, CPN, Ashley Sutton, MD, Brandy Baldwin, RN, BSN, Jeffrey Phillips, RN, MSN, CEN, Edward Sammons, BSN, CFRN, SSB, John Prieur, MA, Melissa Hines, MD, Angela Bukowski, RN, BSN, Angela Ford, MSW and Kimberly Erickson, MD, UNC Healthcare, Fuquay Varina NC

Extensive research has shown for optimal patient care and outcomes, it is vital that the care of a trauma patient be primarily managed a trauma service due specialized skills and expertise a trauma surgeon possesses. Per the American College of Surgeons (ACS), less than 10 percent of pediatric trauma patients should be admitted to nonsurgical services (NSS). At our institution, the number of pediatric trauma patients admitted to NSS from 5/2013-4/2014 increased to 18 percent. In response, a multi-disciplinary team was assembled in 7/2014 and, using DMAIC methodology, was tasked to evaluate and develop a sustainable process improvement plan to reduce the pediatric nonsurgical admission rate and ensure optimal care of pediatric trauma patients admitted to our institution. Iterative process changes were implemented and included educational interventions across departments, dissemination of a simplified flow diagram for admission of injured patients and creation of a direct dial phone number for pediatric trauma attending consultation to determine the appropriate admission service for injured patients when necessary. Process change was analyzed using statistical process control charts and 2-Sample t Test for means and interpreted using standard rules. The monthly mean percent of admissions to NSS following interventions was reduced from 18 percent to 5 percent during the four months following the intervention phase (p <0.005). Thus, a multi-disciplinary effort resulted in reduction of pediatric trauma patients inappropriately admitted to NSS using a systematic improvement approach.

Objective: The learner will be able to explain how the use of DMAIC methodology can be utilized to improve process or system issues.

Objective Content: DMAIC methodology is a data-drive quality and performance strategy to eliminate defects in system. Specific examples of its use to address a system or process issue such as extended wait times for procedures, ED throughput, or lack of standardization in clinical processes. Why it works, because it is a systematic way to define a problem/issue, measure the current process, collect data and identify gaps, analyze the root cause of the problem or issue and prioritize the key steps to improve the process, improve allows to test and implement the solutions using plan, do, check and act cycle. Lastly establishing a process to sustain and control the improvements and develop a response plan for process drift or instability. When DMAIC methodology is utilized effectively, can show a statistically significant improvement in a process, eliminate waste, introduce standardization, increase efficiency and reduce the impact of system issues.


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