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Bridging the Gap

Utilizing a Pediatric Trauma Care Coordinator to Reduce Disparities for Pediatric Trauma Follow-Up Care

McRoberts, Christina M. RN; Bohlen, Nie MSN, RN; Wills, Hale E. MD, MS

doi: 10.1097/JTN.0000000000000448
QUALITY IMPROVEMENT
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An American College of Surgeons–verified Level I pediatric trauma center found that some children with severe and complex injuries experienced disruptions in trauma follow-up care because of the lack of centralized care coordination after hospital discharge. A review of the literature identified little guidance to address this issue. A quality improvement project assessed the gaps in care, identified high-risk patients, and developed a novel pediatric trauma care coordinator (PTCC) nursing position to bridge the gap. Enhancements to the trauma registry software helped create a log of family and provider communication events with and interventions by the PTCC. High-risk patients were defined as those with either a traumatic brain injury plus 1 other organ system injury requiring surgical specialist follow-up, or those with 3 or more different organ system injuries requiring follow-up with a surgical specialist. Costly return to health care (CRH), which we defined as emergency department visits for 72 hr or less or unplanned readmissions of 30 day or less after hospital discharge was selected as the primary outcome measure and assessed during the pre- and postimplementation periods. In the 12-month preimplementation period, 14 patients had a CRH rate of 14%, compared with the 12-month postimplementation period in which 18 patients had a CRH rate of 0%. Patients received a mean of 21.2 communication events and 14.1 intervention events from the PTCC in the postimplementation period. This report details the process of developing and implementing a PTCC nursing position, the tasks involved, and the initial results of this novel program.

Department of Surgery, Trauma Division, Hasbro Children's Hospital, Providence, Rhode Island (Ms McRoberts); Depart-ment of Surgery, Trauma Division, Rhode Island Hospital, Providence (Ms Bohlen); and Division of Pediatric Surgery, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, Rhode Island (Dr Wills).

Correspondence: Christina M. McRoberts, RN, Department of Surgery, Trauma Division, Hasbro Children's Hospital, 593 Eddy St, APC 457, Providence, RI 02903 (cmcroberts@lifespan.org).

Institutional review board (IRB) statement: The Lifespan IRB deemed this project quality assurance/quality control as it did not meet the definition of Human Subject Research.

Hale E. Wills is currently receiving support from the following grants NIMH (1R01MH108641-01A1), NHLBI (5R21HL128863-02), and NIAAA (1R01AA025914-01). For the remaining authors, there are no conflicts of interest.

Copyright © 2019 by the Society of Trauma Nurses.