Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool

Kate Curtis, Belinda Kennedy, Andrew J. A. Holland, Gary Tall, Holly Smith, Soundappan S. V. Soundappan, Brian Burns, Rebecca J. Mitchell, Kellie Wilson, Allan Loudfoot, Michael Dinh, Timothy Lyons, Tona Gillen, Stuart Dickinson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Methods: Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. Results: A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2–12) years, the median ISS was 25 (IQR 16–30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89%). Conclusion: The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.

LanguageEnglish
Pages1089-1096
Number of pages8
JournalInjury
Volume50
Issue number5
DOIs
Publication statusPublished - 1 May 2019

Fingerprint

Peer Review
Pediatrics
Wounds and Injuries
Injury Severity Score
New South Wales
Quality of Health Care
Trauma Centers
Critical Care
Standard of Care
Health Services
Medical Records
Consensus
Nurses
Communication

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Adverse event
  • Emergency
  • Human factors
  • Injury
  • Morbidity
  • Mortality
  • Nursing
  • Paediatric
  • Peer review

Cite this

Curtis, K., Kennedy, B., Holland, A. J. A., Tall, G., Smith, H., Soundappan, S. S. V., ... Dickinson, S. (2019). Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool. Injury, 50(5), 1089-1096. https://doi.org/10.1016/j.injury.2019.01.028
Curtis, Kate ; Kennedy, Belinda ; Holland, Andrew J. A. ; Tall, Gary ; Smith, Holly ; Soundappan, Soundappan S. V. ; Burns, Brian ; Mitchell, Rebecca J. ; Wilson, Kellie ; Loudfoot, Allan ; Dinh, Michael ; Lyons, Timothy ; Gillen, Tona ; Dickinson, Stuart. / Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool. In: Injury. 2019 ; Vol. 50, No. 5. pp. 1089-1096.
@article{d7cbac373891461e9844eee3bd0ef223,
title = "Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool",
abstract = "Background: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Methods: Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. Results: A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2–12) years, the median ISS was 25 (IQR 16–30). The peer-review identified a combination of clinical (85{\%}), systems (51{\%}) and communication (12{\%}) problems that contributed to difficulties in care delivery. In 85{\%} of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89{\%}). Conclusion: The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.",
keywords = "Adverse event, Emergency, Human factors, Injury, Morbidity, Mortality, Nursing, Paediatric, Peer review",
author = "Kate Curtis and Belinda Kennedy and Holland, {Andrew J. A.} and Gary Tall and Holly Smith and Soundappan, {Soundappan S. V.} and Brian Burns and Mitchell, {Rebecca J.} and Kellie Wilson and Allan Loudfoot and Michael Dinh and Timothy Lyons and Tona Gillen and Stuart Dickinson",
note = "Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.injury.2019.01.028",
language = "English",
volume = "50",
pages = "1089--1096",
journal = "Injury",
issn = "0020-1383",
publisher = "Elsevier",
number = "5",

}

Curtis, K, Kennedy, B, Holland, AJA, Tall, G, Smith, H, Soundappan, SSV, Burns, B, Mitchell, RJ, Wilson, K, Loudfoot, A, Dinh, M, Lyons, T, Gillen, T & Dickinson, S 2019, 'Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool', Injury, vol. 50, no. 5, pp. 1089-1096. https://doi.org/10.1016/j.injury.2019.01.028

Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool. / Curtis, Kate; Kennedy, Belinda; Holland, Andrew J. A.; Tall, Gary; Smith, Holly; Soundappan, Soundappan S. V.; Burns, Brian; Mitchell, Rebecca J.; Wilson, Kellie; Loudfoot, Allan; Dinh, Michael; Lyons, Timothy; Gillen, Tona; Dickinson, Stuart.

In: Injury, Vol. 50, No. 5, 01.05.2019, p. 1089-1096.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool

AU - Curtis, Kate

AU - Kennedy, Belinda

AU - Holland, Andrew J. A.

AU - Tall, Gary

AU - Smith, Holly

AU - Soundappan, Soundappan S. V.

AU - Burns, Brian

AU - Mitchell, Rebecca J.

AU - Wilson, Kellie

AU - Loudfoot, Allan

AU - Dinh, Michael

AU - Lyons, Timothy

AU - Gillen, Tona

AU - Dickinson, Stuart

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Methods: Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. Results: A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2–12) years, the median ISS was 25 (IQR 16–30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89%). Conclusion: The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.

AB - Background: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. Methods: Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. Results: A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2–12) years, the median ISS was 25 (IQR 16–30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89%). Conclusion: The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.

KW - Adverse event

KW - Emergency

KW - Human factors

KW - Injury

KW - Morbidity

KW - Mortality

KW - Nursing

KW - Paediatric

KW - Peer review

UR - http://www.scopus.com/inward/record.url?scp=85060193054&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2019.01.028

DO - 10.1016/j.injury.2019.01.028

M3 - Article

VL - 50

SP - 1089

EP - 1096

JO - Injury

T2 - Injury

JF - Injury

SN - 0020-1383

IS - 5

ER -