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Wooldridge A, Carayon P, Hoonakker P, Hose BZ, Ross J, Kohler JE, Brazelton T, Eithun B, Kelly MM, Dean SM, Rusy D, Durojaiye A, Gurses AP. Complexity of the pediatric trauma care process: Implications for multi-level awareness. COGNITION, TECHNOLOGY & WORK (ONLINE) 2019; 21:397-416. [PMID: 31485191 PMCID: PMC6724740 DOI: 10.1007/s10111-018-0520-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/23/2018] [Indexed: 06/02/2023]
Abstract
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e. safety in complex systems. We discuss three levels of awareness (individual, team and organizational) and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration and decision making. A challenge to team awareness is inadequate "non-technical" skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, by using process modeling or simulation.
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Affiliation(s)
- Abigail Wooldridge
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC 9123, Madison WI 53705, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Department of Surgery Administration MC: 7375, Madison WI 53792, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison WI 53792, USA
| | - Michelle M Kelly
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ashimiyu Durojaiye
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
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5
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Ruffing T, Danko S, Danko T, Henzler T, Winkler H, Muhm M. [Injuries in children and adolescents in emergency services]. Unfallchirurg 2015; 119:654-63. [PMID: 25898996 DOI: 10.1007/s00113-015-2746-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A differentiated knowledge of trauma in children and adolescents is essential for the treatment of injured minors. The aim of this study was to present the focus of treatment in trauma emergency services. MATERIAL AND METHODS Over a period of 2 years all acutely injured children and adolescents (n = 4784) in the emergency service were analyzed prospectively. The data were analyzed according to sex, age, date of examination, indications for x-ray imaging, diagnosis and therapy. RESULTS Seasonal differences in the treatment spectrum were detected. In total 34.4 % of the patients presented with bruises/contusions, 23 % wounds, 19.9 % fractures, 14.9 % sprains/strains/ligament ruptures, 4.1 % craniocerebral trauma, 1.5 % dislocations, 1.1 % muscle/tendon injuries and 0.9 % burns. Of the patients 60 % underwent an x-ray examination and 8.3 % were hospitalized. Different injuries were found in the different age groups. Most fractures (25.7 %) were found at the distal forearm and most osteosyntheses (22.5 %) were also carried out at this anatomical location. CONCLUSION Knowledge of the frequency and age dynamics is essential for competent treatment of injuries in children and adolescents. Analysis of the reality of the treatment in emergency services allows a much better evaluation of the requirements with respect to this clientele. The collected data can serve as a basis for the development of major capability foci, training concepts, treatment algorithms as well as prevention measures.
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Affiliation(s)
- T Ruffing
- Klinik für Unfallchirurgie und Orthopädie 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland.
| | - S Danko
- Klinik für Unfallchirurgie und Orthopädie 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
| | - T Danko
- Klinik für Unfallchirurgie und Orthopädie 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
| | - T Henzler
- Institut für Klinische Radiologie und Nuklearmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - H Winkler
- Klinik für Unfallchirurgie und Orthopädie 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
| | - M Muhm
- Klinik für Unfallchirurgie und Orthopädie 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
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