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

doi: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

Injury. 2019 May;50(5):1089-1096. doi: 10.1016/j.injury.2019.01.028. Epub 2019 Jan 16.

Authors

Affiliations

¹ Susan Wakil School of Nursing and Midwifery, The University of Sydney, NSW, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia; The George Institute for Global Health, Sydney, Australia; Illawarra Health and Medical Research Institute, NSW, Australia.
² Susan Wakil School of Nursing and Midwifery, The University of Sydney, NSW, Australia. Electronic address: Belinda.kennedy@sydney.edu.au.
³ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁴ NSW Ambulance, Sydney, Australia.
⁵ Northern Sydney LHD, NSW, Australia.
⁶ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; NSW Ambulance, Sydney, Australia.
⁷ Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
⁸ Sydney Children's Hospital, NSW, Australia.
⁹ NSW Institute of Trauma and Injury Management (ITIM), Australia; Sydney Local Health District, NSW, Australia.
¹⁰ Department of Forensic Medicine Newcastle, NSW, Australia.
¹¹ Lady Cilento Children's Hospital, Brisbane, Australia.
¹² Human Risk Solutions, VIC, Australia.

PMID: 30683570
DOI: 10.1016/j.injury.2019.01.028

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.

MeSH terms

Child
Child, Preschool
Critical Care / organization & administration*
Critical Care / standards
Female
Humans
Injury Severity Score
Male
Medical Records / statistics & numerical data
New South Wales / epidemiology
Peer Review, Health Care
Survival Rate / trends
Trauma Centers / organization & administration*
Triage
Wounds and Injuries / mortality
Wounds and Injuries / therapy*