Perineal Injury via Personal Watercraft Hydrostatic Jet: A Case Report.

BACKGROUND: Traumatic injuries resulting from personal watercraft hydrostatic jets are expected to increase as personal watercrafts are affordable, portable, and used in an increasingly wide range of locales. CASE PRESENTATION: This case study presents an unusual severe perineal injury in a 17-year-old adolescent girl resulting from a fall from a personal watercraft and contact with the vehicle's hydrostatic jet. This case report provides an overview of the mechanism, treatment, and prevention of personal watercraft injuries. CONCLUSION: Knowledge of this mechanism's potential for serious morbidity and mortality, patient assessment and management principles, and injury prevention strategies are essential to providing effective trauma center care.

Improving Timeliness of Pediatric Emergency Department Admissions.

INTRODUCTION: The goal of this quality improvement project was to improve timing, communication, and continued care for pediatric patients who present to the emergency department at a Level I pediatric trauma center and require inpatient admission. METHODS: Using continuous improvement methodology, a patient flow process was created to improve the throughput of pediatric patients requiring inpatient admission from the emergency department, aimed at decreasing the time from decision to admit to actual admission. The new workflow included ED and inpatient nursing collaboration, with nursing leaders coordinating patient transfer. RESULTS: Baseline data indicated that, in 2019, patients admitted to a short-stay pediatric unit from the emergency department had an average time of 106.8 minutes from decision to admit to the actual admission. After the implementation of a new admission process, time from decision to admit to actual admission decreased from a mean of 106.8 minutes to 82.84 minutes for patients admitted to a short-stay unit. This illustrates an improvement from 59.75% to 68.75% of patients admitted within 60 minutes from ED admission to arrival on a short-stay unit. This model was then replicated throughout other units in the hospital. DISCUSSION: There are no known benchmark data to guide practice for rapid admission from the pediatric emergency department to inpatient units and continuing care. This quality improvement project demonstrates a model that has been successful admitting patients in an efficient, time-controlled manner. Additional research is needed to document benchmarks for admission timing and to demonstrate other measurable outcomes in patient care.

Comparison of paper and electronic documentation for trauma activations in a pediatric trauma center.

BACKGROUND: There are limited data on the accuracy of documentation of trauma activations in the electronic medical record (EMR) compared with a paper chart. Our primary objective was to compare the accuracy of documentation between a paper chart and EMR in pediatric trauma. METHODS: We studied video recordings of trauma activations at a level 1 pediatric trauma center. These videos were reviewed, and data points collected were used to compare accuracy of documentation in the paper chart and EMR. RESULTS: We reviewed 106 videos with 1614 data points collected. Of those, 805 data points were compared with their corresponding paper chart with 710 data points correctly documented (88.2%). The remaining 809 data points were compared with their corresponding electronic documentation after implementation of the EMR with 681 data points being correctly documented (84.2%). Overall, we found that paper documentation was significantly more accurate than the EMR (p = 0.019). When analyzed in subcategories of pre-arrival information, primary and secondary survey, and interventions, paper documentation was found to be significantly more accurate than the EMR for components of the primary and secondary survey (87.3% vs. 80.4%, p = 0.001). There was no significant difference in accuracy of documentation between paper and EMR for pre-arrival information (88.1% vs. 89.4%) or interventions (90.3% vs. 92%). CONCLUSION: Documentation of trauma activations is overall more accurate using a paper chart than EMR. Although documentation was accurate for most categories using both a paper chart and EMR, we found significantly less accuracy in documentation of the primary and secondary survey in the EMR.

The response of a pediatric ED to COVID-19.

ABSTRACT: At the beginning of the pandemic, little was known about the effect of COVID-19 on children, urging pediatric health care systems to rapidly, efficiently, and safely address new challenges. This article describes structural, procedural, and functional changes developed in a pediatric ED to respond to the COVID-19 pandemic. The discussion also includes case studies to illustrate the changes made.

Implementation of a standardized screening program for risk of posttraumatic stress disorder among youth hospitalized with injury.

Children with pediatric injury and their parents are at risk for developing posttraumatic stress disorder (PTSD). Although challenging to implement, standardized screening for risk of developing PTSD can identify families most at risk. The current retrospective, chart review study evaluated the implementation of a clinical program that integrated screening for risk of PTSD into standard care for youth admitted to a Level I pediatric trauma center due to injury. Advanced practice nurses administered the Screening Tool for Early Predictors of PTSD (STEPP), a brief screen that evaluates risk of developing PTSD for injured children (ages 8-17 years) and their parents. Positive parent or child STEPPs prompted a referral to psychology for an inpatient consultation. Data were collected via review of electronic medical records and trauma program registry, including demographic, injury, and admission information, completion of and result on the STEPP, and completion of a psychology consultation. During the 2.5 year study period, 1,153 youth (birth-17 years) were admitted due to injury. Among those eligible for the STEPP (i.e., ≥8 years; N = 562), 67% completed the STEPP. Among those who completed the STEPP, 25% had positive parent or child screens and 68% of these completed an inpatient psychology consultation. Standardized screening was related to significantly higher use of inpatient psychology services compared with a control sample not eligible for screening (i.e., <8 years). STEPP scores varied by demographic, admission and injury factors. Results suggest standardized screening is feasible and improves reach of trauma-informed care. Barriers and facilitators of this screening program are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Certification Matters.

As professionals, we have many opportunities to prove our expertise in our field. Professional Certification is one of those opportunities. Certified nurses have reported feeling more empowered, with better collaborative relationships, as well as believing that they provide better care. Nurses also have perceived intrinsic value to obtaining certification in a specialty practice area. The certification process attempts to demonstrate that the nurse has exceeded the minimal standards and exhibits a high level of competence over the subject area. Leaders should continue to encourage their team members to obtain professional certification in their specialty areas of practice.

Injury Prevention at the Bedside.

It is estimated that 1 in 4 children will have an unintentional injury that requires medical attention or intervention by the time they are 21 years of age. Emergency department staff have an opportunity to engage families in injury prevention messaging right at the bedside. Having staff who participate in an injured patient's care can better prepare a family or prevent another injury. Our emergency department staff identified these moments as prime teaching opportunities and worked with our trauma team to develop resources and education for patients and families that present to our department.

Defining Leadership in a Changing Time.

The purpose of this article is to discuss the difference between leadership and management. Leadership and management have been discussed for many years. Both are important to achieve success in health care, but what does that really mean? Strong leaders possess qualities that inspire others to follow them. This fosters team engagement, goal achievement, and ultimately drives outcomes. Managers plan, organize, and coordinate. It takes dedication, motivation, and passion to be more than a manager and be a good leader. There is not a single correct leadership style, but there are important characteristics that all leaders must demonstrate to get the desired results with the team. In a time when health care is rapidly changing, leadership is important at all levels of an organization.

Creating a comprehensive bicycle safety program.

Trauma centers must play a role in injury prevention. Pediatric trauma centers have the ability to create injury prevention programs targeting all children. After analyzing our trauma registry data, we determined that bicycle injuries are a significant mechanism of injury in children and developed strategies aimed at preventing such injuries. Along with support from Kohl's Cares, we are able to achieve our mission of keeping children in our community healthy and safe. Our comprehensive bicycle safety program is targeted to various ages and learning styles and aims to increase bicycle safety and helmet use among children in our region.

Plotting performance improvement progress through the development of a trauma dashboard.

Performance improvement processes are the core of a pediatric trauma program. The ability to identify, resolve, and trend specific indicators related to patient care and to show effective loop closure can be especially challenging. Using the hospital's overall quality process as a template, the trauma program built its own electronic dashboard. Our maturing trauma PI program now guides the overall trauma care. All departments own at least one performance indicator and must provide action plans for improvement. Utilization of an electronic dashboard for trauma performance improvement has provided a highly visible scorecard, which highlights successes and tracks areas needing improvement.