Pamela M Choi1, Charles Hong2, Steve Woods2, Brad W Warner2, Martin S Keller2. 1. Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. Electronic address: choip@wustl.edu. 2. Division of Pediatric Surgery, St Louis Children's Hospital, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
Abstract
PURPOSE: The purpose of this study was to determine the early impact of American College of Surgeons (ACS)-level-1 verification at an established pediatric trauma center. METHODS: Following IRB approval, we conducted a retrospective review of all trauma patients treated at a level-1 state-designated pediatric trauma center, comparing 2years before (2009-2010) and 2years after ACS-verification (mid-2012-mid-2014). Statistical significance was defined as p<0.05. RESULTS: Before verification, 2105 trauma patients were admitted to our institution compared to 2248 patients admitted after ACS-verification. Overall, there were no differences in mean age or injury severity score (ISS). Hospital and pediatric intensive care unit (PICU) length of stay (LOS), ventilator days, and mortality were also unchanged. Through incorporation of clinical pathways, the number of PICU admissions decreased significantly from 17.2% to 13.7%. Morbidity in the form of hospital-acquired conditions (HACS) also decreased following verification, most notably through reduction in pneumonias. Decubitus ulcers and nosocomial infections reached their nadir by 2014. Hospital readmission rates also decreased. CONCLUSIONS: ACS-verification at a level-1 pediatric trauma center is associated with an immediate benefit to patient outcomes. Enhanced tracking and institutional policy changes resulted in fewer HACS. Further cost-saving and improved outcomes because of ACS-verification may be amplified over time.
PURPOSE: The purpose of this study was to determine the early impact of American College of Surgeons (ACS)-level-1 verification at an established pediatric trauma center. METHODS: Following IRB approval, we conducted a retrospective review of all traumapatients treated at a level-1 state-designated pediatric trauma center, comparing 2years before (2009-2010) and 2years after ACS-verification (mid-2012-mid-2014). Statistical significance was defined as p<0.05. RESULTS: Before verification, 2105 traumapatients were admitted to our institution compared to 2248 patients admitted after ACS-verification. Overall, there were no differences in mean age or injury severity score (ISS). Hospital and pediatric intensive care unit (PICU) length of stay (LOS), ventilator days, and mortality were also unchanged. Through incorporation of clinical pathways, the number of PICU admissions decreased significantly from 17.2% to 13.7%. Morbidity in the form of hospital-acquired conditions (HACS) also decreased following verification, most notably through reduction in pneumonias. Decubitus ulcers and nosocomial infections reached their nadir by 2014. Hospital readmission rates also decreased. CONCLUSIONS: ACS-verification at a level-1 pediatric trauma center is associated with an immediate benefit to patient outcomes. Enhanced tracking and institutional policy changes resulted in fewer HACS. Further cost-saving and improved outcomes because of ACS-verification may be amplified over time.
Authors: Onyinyechi I Ukwuoma; Michael Dingeldein; Johnathan M Sheele; Alexandre T Rotta; Carolyn Apperson-Hansen; Leslie Dingeldein Journal: J Emerg Med Date: 2020-06-24 Impact factor: 1.484