Challenges of Disposition Decision Making for Pediatric Trauma Patients in the Emergency Department
About 9.2 million children visit the emergency department (ED) in the US annually because of trauma and 20% experience a missed injury. Upon arriving to the hospital, physicians evaluate the child and make the ED disposition decision of whether to admit, operate or discharge. The objective of this study is to report the challenges mentioned by healthcare professionals about ED disposition decision making. We conducted 11 interviews with 12 healthcare professionals and identified 2 challenges of ED disposition decision making. The first challenge was timing of the decision; e.g., an ED nurse explained that a quick decision by physicians is important for providing timely patient care to critically ill children. The second challenge was leadership and team organization; e.g., the OR nurse and surgery resident both mentioned the need to know who to listen to so that they can understand what to do. Analyzing these challenges to ED disposition decision making can help to identify sociotechnical solutions for enhancing team situation awareness.
KeywordsPediatric trauma Decision making Coordination ED disposition Patient safety Team situational awareness
Funding for this research was provided by the Agency for Healthcare Research and Quality (AHRQ) [Grant No. R01 HS023837]. The project described was also supported by the Clinical and Translational Science Award (CTEAM SA) 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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