Decision-making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

被引:1
作者
Gregory, Megan E. E. [1 ,9 ]
Truelove, Annie [2 ]
Ahmad, Fahd [3 ]
Corwin, Daniel [4 ]
Tzimenatos, Leah [5 ]
Oglesbee, Scott J. J. [6 ]
Herman, Martin J. J. [7 ]
Leonard, Julie C. C. [8 ]
机构
[1] Univ Florida, Dept Hlth Outcomes & Biomed Informat, Gainesville, FL USA
[2] Nationwide Childrens Hosp, Abigail Wexner Res Inst, Columbus, OH USA
[3] Washington Univ St Louis, Sch Med, Dept Pediat, Div Emergency Med, St Louis, MO USA
[4] Childrens Hosp Philadelphia, Dept Pediat, Div Emergency Med, Philadelphia, PA USA
[5] Univ Calif Sacramento, Davis Sch Med, Dept Emergency Med, Sacramento, CA USA
[6] Univ New Mexico Hlth Sci Ctr, Dept Emergency Med, Div Pediat Emergency Med, Albuquerque, NM USA
[7] St Christophers Hosp Children, Philadelphia, PA USA
[8] Ohio State Univ, Nationwide Childrens Hosp, Dept Pediat, Div Emergency Med,Coll Med, Columbus, OH USA
[9] Univ Florida, Dept Hlth Outcomes & Biomed Informat, 2004 Mowry Rd,Room 3224, Gainesville, FL 32611 USA
关键词
clinical decision support; imaging; pediatric trauma; teamwork; RULE; RADIOGRAPHY; CRITERIA; INJURY;
D O I
10.1002/emp2.13024
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
ObjectiveCervical spine imaging decision-making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department-trauma team dynamics may affect implementation of such a tool. MethodsWe interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision-making process. Data were coded following a framework-driven deductive coding process and thematic analysis was used. ResultsForty-eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I-III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision-making process. ConclusionsImplementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.
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页数:20
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