Impact of a Dedicated Advanced Practice Provider Model for Pediatric Trauma and Burn Patients.

Abstract

A free-standing, academic Level 1 pediatric trauma and verified pediatric burn center created a dedicated trauma and burn service advanced practice provider role, and restructured rounds. The changes were implemented to improve patient care. A pre and postintervention study using historical controls was performed to compare 18 months prior (preintervention) and 18 months following (postintervention) practice changes. Data collection included demographics, injury characteristics, length of stay (LOS), complications, and patient satisfaction results. When compared with the preintervention period, the postintervention period had a higher patient volume and an increased number of severely injured patients. Mean LOS was stable for all patients and trauma patients, as were the complication rates related to trauma and burns. However, the mean LOS/total body surface area (TBSA) burned decreased from 1.36 to 1.04 days/TBSA (p = .160) in burn patients and from 0.84 to 0.62 days/TBSA (p = .060) in those with more than 5% TBSA. Patient satisfaction scores were stable in the categories of nursing care and the child's physician. Despite an increase in the volume and severity of patients, there was a clinically meaningful decrease in burn patient LOS/TBSA. The addition of a dedicated advanced practice provider and restructured trauma service appears to provide a benefit to pediatric burn patients.