188 Impact of Adult Level 1 Trauma Designation on the Timeliness of Pediatric Emergency Department Computed Tomography Scans

Abstract

Timeliness in the provision of medical care is an essential aspect of patient safety and health care quality. Given the unpredictable nature of the emergency department (ED) with regards to variation in disease acuity and patient volume, it is essential to gather crucial information in a prompt fashion to aid medical decisionmaking and patient disposition. The adult emergency department of our institution was verified as a Level 1 Trauma Center by the American College of Surgeons in December 2015, 24 years after our pediatric emergency department was recognized as a Level 1 Trauma Center. One of the metrics used as an operational benchmark in the ED is imaging interval (time from order of an imaging test to the availability of results). There is a single computed tomography (CT) scanner located in the emergency department, which is utilized by both the adult and pediatric sections. With an anticipated increase in the adult ED patient volume following its new status, we sought to assess the impact of adult Level 1 Trauma designation on the timeliness of pediatric non-trauma CT scans in an emergency department. Retrospective chart review of patients in the pediatric emergency department who had CT scans was performed. We compared CT scan orders of patients over the same 6-month period prior to and after the adult ED Level 1 Trauma verification, and assessed the time from order to completion of CT scans. The months with historically highest trauma volumes were chosen. All pediatric trauma activations were excluded, as well as duplicate orders and scans performed during EMR downtime. Unpaired student t-tests and Chi-squared tests were used for statistical analyses. There were 218 consecutive CT scans analyzed in 2015, and 193 consecutive CT scans in the same time frame in 2016. About half of the CT scans in both years were head imaging studies, and more males were scanned compared to females. The average time for CT completion prior to adult ED Level 1 verification was 39.5 minutes, compared to 55.5 minutes in the same time frame the next year (p<0.0001). Also, the proportion of children receiving CT scans within 60 minutes from order decreased from 81% in 2015 to 65% in 2016. (p=0.0002; 95% CI 7.4 - 24.4). The new designation of adult Level 1 trauma status in our ED was associated with a significant delay (by more than 40%) in performance of non-trauma pediatric CT scans, and decrease in the likelihood of children receiving CT scans within 60 minutes. These findings may have significant clinical and economic ramifications for pediatric patients and hospitals, and represent the potential "collateral damage" of an institution receiving an upgrade of their adult trauma center to Level 1 status.