Every year, approximately 1,000 injured children are evaluated in the pediatric ED. The Johns Hopkins Children's Center is a level I pediatric trauma center in Baltimore, Maryland, United States. To achieve this, it is necessary to gain a better understanding of patient flow through the trauma center. It is important to minimize the number of care transitions and improve existing care transitions processes. However, such local optimization does not necessarily improve overall system performance due to hospital-wide interdependencies.įurthermore, certain trauma care transitions are associated with higher risks to patient safety,Īnd with the current efforts to contain health care costs, Most research has focused on improving adult patient flow through regional trauma networksĪnd within and around the ED of a trauma center. To the best of our knowledge, there has been little research on the system-based assessment of patient flow through a pediatric trauma center. The sequence of care transitions (or patient pathways) depends on the nature and severity of a patient's injury, and the sum of these pathways (or inhospital patient flow) is a measure of the efficiency of a hospital. Inhospital pediatric trauma care usually begins in the ED and, depending on injury severity, ends in discharge or leads to admission, which involves transitions and care in different areas of the hospital (e.g., operating room, intensive care unit, or floor). Pediatric trauma patients often present with multiple injuries, requiring multidisciplinary care and coordination of diverse team members who work across time and space. The annual direct economic cost of pediatric trauma is estimated to top US$50 billion. Trauma is the leading cause of morbidity and mortality among children in the United States.Įvery year, approximately 9 million children are evaluated in emergency departments (ED) for traumatic injury, resulting in roughly 225,000 admissions, and approximately 10,000 deaths are recorded. Process mining was successfully applied to derive process maps from trauma registry data and to identify opportunities for trauma triage improvement and optimization of PICU use. A larger-than-expected number of discharges from the pediatric intensive care unit (PICU) were identified, with 84.2% involving discharge to home without the need for home care services.
The top five patient pathways were traversed by 92.1% of patients, whereas the top five care transitions accounted for 87.5% of all care transitions. In total, 28 patient pathways and 20 care transitions were identified. The process map for Bravo encounters had a relatively low fitness of 0.887, and 96 (5.6%) encounters were identified as nonconforming with characteristics comparable to Alpha encounters. The process map for the cohort was similar to a validated process map derived through qualitative methods. The Flexible Heuristics Miner algorithm was used to generate a process map for the cohort, and separate process maps for Alpha and Bravo encounters, which were assessed for conformance when fitness value was less than 0.950, with the identification and comparison of conforming and nonconforming encounters. An event log was generated from the admission, discharge, and transfer data from which patient pathways and care transitions were identified and described. To describe a process mining approach for mapping the inhospital flow of pediatric trauma patients, to identify and characterize the major patient pathways and care transitions, and to identify opportunities for patient flow and triage improvement.įrom the trauma registry of a level I pediatric trauma center, data were extracted regarding the two highest trauma activation levels, Alpha ( Inhospital pediatric trauma care typically spans multiple locations, which influences the use of resources, that could be improved by gaining a better understanding of the inhospital flow of patients and identifying opportunities for improvement.
0 kommentar(er)
