Dataset Information

Assessing service quality and access in trauma centers through behavioral health screening, education, and treatment after pediatric injury.

ABSTRACT:

Background

Over 120,000 U.S. children are hospitalized annually for traumatic injury, with approximately 20% developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or depression. The ACS COT recommends that trauma centers address emotional recovery after injury; however, few pediatric trauma centers (PTCs) assess behavioral health symptoms. This study describes results from a survey with PTC providers assessing the landscape of behavioral health screening, education, and treatment.

Methods

Trauma program leaders from 83 US Level I and II trauma centers across 36 states completed a survey assessing center characteristics and decision-making, availability, and perceptions of behavioral health resources.

Results

Nearly half (46%) of centers provide behavioral health screens for pediatric patients, and 18% screen family members, with screens mostly conducted by nurses or social workers for ASD or PTSD. Two-thirds provide child behavioral health education and 47% provide education to caregivers/family. Two-thirds provide treatment connections, typically via referrals or outpatient clinics. Behavioral health screening, education, and treatment connections were rated as very important (M > 8.5/10), with higher ratings for the importance of screening children versus caregivers. Child maltreatment (59%), observed patient distress (53%), child substance use (52%), injury mechanism (42%) and severity (42%) were prioritized in screening decision-making.

Conclusion

Service provision varies by method, resource, and provider, highlighting the lack of a roadmap for centers to provide behavioral health services. Adoption of universal education and screening procedures in PTCs is crucial to increase access to services for injured children and caregivers. PTCs are well-positioned to offer these services.

Level of evidence

Level II.

SUBMITTER: Ridings LE

PROVIDER: S-EPMC9287491 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Assessing service quality and access in trauma centers through behavioral health screening, education, and treatment after pediatric injury.

Ridings Leigh E LE Espeleta Hannah C HC Streck Christian J CJ Davidson Tatiana M TM Litvitskiy Nicole N Bravoco Olivia O Kassam-Adams Nancy N Ruggiero Kenneth J KJ

Journal of pediatric surgery 20220116 11

<h4>Background</h4>Over 120,000 U.S. children are hospitalized annually for traumatic injury, with approximately 20% developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or depression. The ACS COT recommends that trauma centers address emotional recovery after injury; however, few pediatric trauma centers (PTCs) assess behavioral health symptoms. This study describes results from a survey with PTC providers assessing the landscape of behavioral health screening, educatio ...[more]

PMID: 35090719

Similar Datasets

Project description:ObjectiveScreening, brief intervention, and referral to treatment (SBIRT) for adolescent alcohol and drug (AOD) use is recommended to occur with adolescents admitted to pediatric trauma centers. Most metrics on SBIRT service delivery only reference medical record documentation. In this analysis we examined changes in adolescents' perception of SBIRT services and concordance of adolescent-report and medical record data, among a sample of adolescents admitted before and after institutional SBIRT implementation.MethodsWe implemented SBIRT for adolescent AOD use using the Science to Service Laboratory implementation strategy and enrolled adolescents at 9 pediatric trauma centers. The recommended clinical workflow was for nursing to screen, social work to provide adolescents screening positive with brief intervention and referral to their PCP for continued AOD discussions with those. Adolescents screening as high-risk also referred to specialty services. Adolescents were enrolled and contacted 30 days after discharge and asked about their perception of any SBIRT services received. Data were also extracted from enrolled patient's medical record.ResultsThere were 430 adolescents enrolled, with 424 that were matched to their EHR data and 329 completed the 30-day survey. In this sample, EHR documented screening increased from pre-implementation to post-implementation (16.3%-65.7%) and brief interventions increased (27.1%-40.7%). Adolescents self-reported higher rates of being asked about alcohol or drug use than in EHR data both pre- and post-implementation (80.7%-81%). Both EHR data and adolescent self-reported data demonstrated low referral back to PCP for continued AOD discussions.ConclusionsImplementation of SBIRT at pediatric trauma centers was not associated with change in adolescent perceptions of SBIRT, despite improved documentation of delivery of AOD screening and interventions. Adolescents perceived being asked about AOD use more often than was documented. Referral to PCP or specialty care for continued AOD discussion remains an area of needed attention.Trial registrationClinicaltrials.gov NCT03297060.

Project description:BackgroundScreening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that can identify adolescents who use alcohol and other drugs and support proper referral to treatment. Despite an American College of Surgeons mandate to deliver SBIRT in pediatric trauma care, trauma centers throughout the United States have faced numerous patient, provider, and organizational level barriers to SBIRT implementation. The Implementing Alcohol Misuse Screening, Brief Intervention, and Referral to Treatment Study (IAMSBIRT) aimed to implement SBIRT across 10 pediatric trauma centers using the Science-to-Service Laboratory (SSL), an empirically supported implementation strategy. This manuscript aimed to assess trauma center staff preferences and experience with the didactic training, performance feedback, and ongoing coaching elements of the SSL via a retrospective qualitative process evaluation.MethodsNurses, social workers, and site leaders that participated in IAMSBIRT were recruited to complete qualitative exit interviews guided by the Consolidated Framework for Implementation Research. Qualitative interviews were recorded, transcribed, and analyzed by two coders using a directed content analysis approach in NVivo software. Codes were then translated into frequently endorsed themes by the IAMSBIRT study research team.ResultsThirty-six exit interviews were conducted with site leaders, social workers, and nurses across the 10 IAMSBIRT pediatric trauma centers. Findings revealed key strengths as well as areas for improvement across the IAMSBIRT preparation phase and the three elements of the SSL: didactic training, performance feedback, and ongoing coaching. Trauma center staff generally reported that all three elements of the SSL were high quality and helpful for supporting SBIRT implementation. However, staff also noted that performance feedback and ongoing coaching were generally only available to center leadership or to individuals selected by leadership, making it challenging for non-leaders to troubleshoot SBIRT delivery.ConclusionsFindings from the qualitative process evaluation revealed discrepancies in the experience of the SSL strategy between those in leadership roles and those involved in direct care delivery. These results suggest the need for several modifications to the SSL strategy, including increasing engagement of direct care staff in all elements of the SSL throughout the implementation process.Trial registrationClinicaltrials.gov NCT03297060 . Registered 29 September 2017.

Project description:IntroductionOn 24 February 2022, Russia launched a large-scale offensive in Ukraine, resulting in significant casualties to civilians, including children. As part of a seven-stream trauma education initiative, a novel pediatric trauma fundamentals course (PTF) was developed to provide standalone pediatric trauma education by our academic/NGO partnership. The objective of the program was to develop, implement, and evaluate a novel PTF educational course in the active armed conflict zone of Ukraine.MethodsA novel two-day PTF course was internally developed, translated into Ukrainian, and implemented across eight Oblasts (regions) in Ukraine from November 2022 to December 2023. Participants completed pre-and post-assessments in knowledge and self-confidence, and critical skills were assessed against objective skill checklists. Change in knowledge and self-confidence were analyzed, respectively, with the nonparametric Wilcoxon matched-pairs signed-rank test and McNemar's test for paired data. Anonymous course evaluations were solicited after each course. Six to eight-week follow-up surveys were conducted to assess skill utilization and stewardship.ResultsFour hundred and forty-six Ukrainian health care providers were trained during 30 courses across 8 Oblasts in Ukraine during the intervention period. Aggregated knowledge and self-confidence significantly improved across all measures. Ukrainian instructors of courses received higher raw scores across all evaluation points on instructor feedback surveys as compared to international instructors. Six to eight-week follow-up surveys demonstrated participants had positive views of the training, have used the training on patients, and have taught the material to other health care providers.DiscussionOur novel PTF intervention demonstrates a successful partnership-based model for implementing pediatric trauma education in an active conflict zone in Ukraine. Challenges to implementing such programs can be mitigated through strategic partnership-based models between academic institutions and organizations with local knowledge and expertise. Ukrainian instructors provide course experiences similar or superior to international instructors, likely due to multiple factors related to language, culture, and context.

Project description:ImportanceThe National Pediatric Readiness Project is a US initiative to improve emergency department (ED) readiness to care for acutely ill and injured children. However, it is unclear whether high ED pediatric readiness is associated with improved survival in US trauma centers.ObjectiveTo evaluate the association between ED pediatric readiness, in-hospital mortality, and in-hospital complications among injured children presenting to US trauma centers.Design, setting, and participantsA retrospective cohort study of 832 EDs in US trauma centers in 50 states and the District of Columbia was conducted using data from January 1, 2012, through December 31, 2017. Injured children younger than 18 years who were admitted, transferred, or with injury-related death in a participating trauma center were included in the analysis. Subgroups included children with an Injury Severity Score (ISS) of 16 or above, indicating overall seriously injured (accounting for all injuries); any Abbreviated Injury Scale (AIS) score of 3 or above, indicating at least 1 serious injury; a head AIS score of 3 or above, indicating serious brain injury; and need for early use of critical resources.ExposuresEmergency department pediatric readiness for the initial ED visit, measured through the weighted Pediatric Readiness Score (range, 0-100) from the 2013 National Pediatric Readiness Project ED pediatric readiness assessment.Main outcomes and measuresIn-hospital mortality, with a secondary composite outcome of in-hospital mortality or complication. For the primary measurement tools used, the possible range of the AIS is 0 to 6, with 3 or higher indicating a serious injury; the possible range of the ISS is 0 to 75, with 16 or higher indicating serious overall injury. The weighted Pediatric Readiness Score examines and scores 6 domains; in this study, the lowest quartile included scores of 29 to 62 and the highest quartile included scores of 93 to 100.ResultsThere were 372 004 injured children (239 273 [64.3%] boys; median age, 10 years [interquartile range, 4-15 years]), including 5700 (1.5%) who died in-hospital and 5018 (1.3%) who developed in-hospital complications. Subgroups included 50 440 children (13.6%) with an ISS of 16 or higher, 124 507 (33.5%) with any AIS score of 3 or higher, 57 368 (15.4%) with a head AIS score of 3 or higher, and 32 671 (8.8%) requiring early use of critical resources. Compared with EDs in the lowest weighted Pediatric Readiness Score quartile, children cared for in the highest ED quartile had lower in-hospital mortality (adjusted odds ratio [aOR], 0.58; 95% CI, 0.45-0.75), but not fewer complications (aOR for the composite outcome 0.88; 95% CI, 0.74-1.04). These findings were consistent across subgroups, strata, and multiple sensitivity analyses. If all children cared for in the lowest-readiness quartiles (1-3) were treated in an ED in the highest quartile of readiness, an additional 126 lives (95% CI, 97-154 lives) might be saved each year in these trauma centers.Conclusions and relevanceIn this cohort study, injured children treated in high-readiness EDs had lower mortality compared with similar children in low-readiness EDs, but not fewer complications. These findings support national efforts to increase ED pediatric readiness in US trauma centers that care for children.

Project description:BackgroundInjured children initially treated at trauma centers with high emergency department (ED) pediatric readiness have improved survival. Centers with limited resources may not be able to address all pediatric readiness deficiencies, and there currently is no evidence-based guidance for prioritizing different components of readiness. The objective of this study was to identify individual components of ED pediatric readiness associated with better-than-expected survival in US trauma centers to aid in the allocation of resources targeted at improving pediatric readiness.MethodsThis cohort study of US trauma centers used the National Trauma Data Bank (2012-2017) matched to the 2013 National Pediatric Readiness Project assessment. Adult and pediatric centers treating at least 50 injured children (younger than 18 years) and recording at least one death during the 6-year study period were included. Using a standardized risk-adjustment model for trauma, we calculated the observed-to-expected mortality ratio for each trauma center. We used bivariate analyses and multivariable linear regression to assess for associations between individual components of ED pediatric readiness and better-than-expected survival.ResultsAmong 555 trauma centers, the observed-to-expected mortality ratios ranged from 0.07 to 4.17 (interquartile range, 0.93-1.14). Unadjusted analyses of 23 components of ED pediatric readiness showed that trauma centers with better-than-expected survival were more likely to have a validated pediatric triage tool, comprehensive quality improvement processes, a pediatric-specific disaster plan, and critical airway and resuscitation equipment (all p < 0.03). The multivariable analysis demonstrated that trauma centers with both a physician and a nurse pediatric emergency care coordinator had better-than-expected survival, but this association weakened after accounting for trauma center level. Child maltreatment policies were associated with lower-than-expected survival, particularly in Levels III to V trauma centers.ConclusionSpecific components of ED pediatric readiness were associated with pediatric survival among US trauma centers.Level of evidenceTherapeutic/Care Management; Level III.

Dataset Information

Assessing service quality and access in trauma centers through behavioral health screening, education, and treatment after pediatric injury.

Background

Methods

Results

Conclusion

Level of evidence

Publications

Assessing service quality and access in trauma centers through behavioral health screening, education, and treatment after pediatric injury.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets