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Sustained Improvement in Under-Triage of Pediatric Trauma Patients Using a Multidisciplinary and Evidence-Based Approach to Leveling

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Sustained Improvement in Under-Triage of Pediatric Trauma Patients Using a Multidisciplinary and Evidence-Based Approach to Leveling
Benjamin Eithun, MSN, CRNP, RN, CPNP-AC, CCRN1, Barbara Byrne, DNP, RN, PNP-BC1, Ankush Gosain, MD, PhD, FACS, FAAP1,2, 1American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Madison WI, 2Department of Surgery, Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison WI

Objective: Trauma leveling criteria balance the potential harm to individual patients from under-triage (UT) of severe injuries vs. overutilization of resources from over-triage (OT) of lesser injuries. The American College of Surgeons (ACS) recommends a rate of UT?5% and OT=25-50%. We sought to improve UT/OT rates at our ACS Level I Pediatric Trauma Center by (1) improving accuracy in following established leveling criteria and (2) modifying established leveling criteria in an evidence-based fashion to better identify severely-injured children. Results from this prospective Process Improvement project are presented following IRB approval. Data from 2010(pre-study) were used as baseline. Phase I (3 months) of the study involved moving the leveling responsibility from physicians to the nursing Care Team Leaders (CTL). Phase II(3 months) of the study implemented revised activation/leveling criteria based on published ACS&CDC guidelines with a focus on head injuries, the primary finding in UT patients pre-study. Sustainability was assessed by examining 2014 data. At baseline, our UT rate was 10.6% (29/289) and OT rate 37.5% (6/16). In Phase I of the study, accuracy of leveling by CTL was 99% (86/87), UT 8% (8/100), OT 33.3% (7/21). In Phase II, UT declined to 5.1% (4/79) and OT was 40% (2/5). For 2014, UT was 5.3% (36/677) and OT 18.2% (6/27). We have demonstrated accuracy of trauma leveling by Nursing CTL. In applying published ACS&CDC guidelines to our trauma leveling criteria we decreased UT from 10% to 5.1%. This improvement has been sustained over three years, highlighting the value of multidisciplinary and evidence-based approaches to developing trauma leveling criteria.
Objective: Discuss multidisciplinary and evidence-based approaches to define trauma leveling criteria and address under-triage.Objective Content: Trauma activation/leveling responsibility was shifted from MDs to RNs. ACS and CDC recommendations on trauma triage, activation and leveling criteria were used, along with data from the local trauma registry, to modify trauma leveling criteria.


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