Cognition, Technology & Work

, Volume 21, Issue 3, pp 397–416 | Cite as

Complexity of the pediatric trauma care process: implications for multi-level awareness

  • Abigail R. WooldridgeEmail author
  • Pascale Carayon
  • Peter Hoonakker
  • Bat-Zion Hose
  • Joshua Ross
  • Jonathan E. Kohler
  • Thomas Brazelton
  • Benjamin Eithun
  • Michelle M. Kelly
  • Shannon M. Dean
  • Deborah Rusy
  • Ashimiyu Durojaiye
  • Ayse P. Gurses
Original Article


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 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, using process modeling or simulation.


Complexity Awareness Sociotechnical systems Patient safety Pediatric trauma care Fluid teams 



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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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Industrial and Systems EngineeringUniversity of Wisconsin-MadisonMadisonUSA
  2. 2.Center for Quality and Productivity ImprovementUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  5. 5.Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  6. 6.American Family Children’s HospitalUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  7. 7.School of NursingUniversity of Wisconsin-MadisonMadisonUSA
  8. 8.Department of AnesthesiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  9. 9.Center for Health Care Human Factors, Armstrong Institute for Patient Safety and QualityJohns Hopkins UniversityBaltimoreUSA
  10. 10.Division of Health Sciences Informatics, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  11. 11.Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  12. 12.Whiting School of EngineeringJohns Hopkins UniversityBaltimoreUSA
  13. 13.Department of Industrial and Enterprise Systems EngineeringUniversity of Illinois at Urbana-ChampaignUrbanaUSA

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