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The Path to Verification as a Level 2 Pediatric Trauma Center Leads to Improved Patient Care

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The Path to Verification as a Level 2 Pediatric Trauma Center Leads to Improved Patient Care
Nicole Fox, MD, MPH, FACS and Stacey Staman RN, MSN, CCRN, Cooper University Hospital, Camden NJ

Objective:
Background: The majority of injured children in the United States are not treated at pediatric trauma centers. Our adult level 1 trauma center sees a high volume of pediatric patients and committed to pursuing verification as a level 2 pediatric trauma center. We hypothesized that preparing for verification would improve the care of our pediatric trauma patients by identifying areas requiring process improvement (PI).
Methods: PI data for patients < 15 years old admitted (April 2013-March 2014) was reviewed and two areas of concern were identified: the management of blunt splenic injury (BSI) and the transfer of supracondylar fractures (SF). A clinical pathway for the management of BSI was created and implemented. Criteria for the management of SF and indications for transfer were established. Education was provided to all practitioners caring for pediatric trauma patients. Subsequently, cases of BSI and SF were prospectively observed (April 2014-December 2014).
Results: In the time period prior to intervention, 11 patients were admitted with BSI. Seven patients (64%) had a grade III-V injury and 4 (57%) underwent splenectomy. Following intervention, 8 patients were admitted with BSI. Five patients (63%) had a grade III-V injury and no patients (0%) underwent splenectomy. Prior to intervention, 2 out of 10 (20%) patients admitted with SF were transferred to another institution. Following intervention, 9 patients were admitted with SF and none (0%) were transferred. Conclusion: The process of preparing for pediatric verification led to a reduction in splenectomy rates and transfers out of SF.
Objective: At the end of this activity, the learner will be able to discuss issues faced by adult trauma centers pursuing additional verification as pediatric trauma centers.Objective Content: A significant number of pediatric trauma patients are cared for at adult trauma centers. Although there may be variations in practice, the quality of care provided at these centers may be defined by infrastructure, process and outcome. It is incumbent upon adult trauma centers, regardless of pediatric designation, to critically evaluate these components related to the care of pediatric patients at their center.


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