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Information flow during pediatric trauma care transitions: things falling through the cracks

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Abstract

Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Every year, nearly 10 million children are evaluated in emergency departments (EDs) for traumatic injuries, resulting in 250,000 hospital admissions and 10,000 deaths. Pediatric trauma care in hospitals is distributed across time and space, and particularly complex with involvement of large and fluid care teams. Several clinical teams (including emergency medicine, surgery, anesthesiology, and pediatric critical care) converge to help support trauma care in the ED; this co-location in the ED can help to support communication, coordination and cooperation of team members. The most severe trauma cases often need surgery in the operating room (OR) and are admitted to the pediatric intensive care unit (PICU). These care transitions in pediatric trauma can result in loss of information or transfer of incorrect information, which can negatively affect the care a child will receive. In this study, we interviewed 18 clinicians about communication and coordination during pediatric trauma care transitions between the ED, OR and PICU. After the interview was completed, we surveyed them about patient safety during these transitions. Results of our study show that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To safely manage the transition of this fragile and complex population, we need to find ways to better manage the information flow during these transitions by, for instance, providing technological support to ensure shared mental models.

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Acknowledgements

Funding for this research was provided by the Agency for Healthcare Research and Quality (AHRQ) [Grant no. R01 HS023837]. The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS), [Grant UL1TR002373]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. We thank the study participants, as our research would not be possible without them.

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Authors and Affiliations

  1. Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3124 Engineering Centers Building, 1550 Engineering Drive, Madison, WI, 53706, USA

    Peter Leonard Titus Hoonakker

  2. Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, 209A Transportation Building, 104 South Mathews Avenue, Urbana, IL, 61801, USA

    Abigail Rayburn Wooldridge

  3. Center for Quality and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3139 Engineering Centers Building, 1550 Engineering Drive, Madison, WI, 53706, USA

    Bat-Zion Hose & Pascale Carayon

  4. American Family Children’s Hospital, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison, WI, 53792, USA

    Ben Eithun

  5. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    Thomas Berry Brazelton III, Shannon Mason Dean & Michelle Merwood Kelly

  6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    Jonathan Emerson Kohler

  7. Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    Joshua Chud Ross

  8. Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    Deborah Ann Rusy

  9. Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15th Floor, Baltimore, MD, 21202, USA

    Ayse Pinar Gurses

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  1. Peter Leonard Titus Hoonakker
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Corresponding author

Correspondence to Peter Leonard Titus Hoonakker.

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Human and animal rights statement

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by University of Wisconsin - Madison Institutional Review Board.

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Informed consent was obtained from all individuals participating in the study.

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Hoonakker, P.L.T., Wooldridge, A.R., Hose, BZ. et al. Information flow during pediatric trauma care transitions: things falling through the cracks. Intern Emerg Med 14, 797–805 (2019). https://doi.org/10.1007/s11739-019-02110-7

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