Development, implementation and prospective evaluation of guidelines for transfer of severely injured children to specialist centres

Authors: Patterson, M.; Jones, M.; Lloyd, D. A.

Source: British Journal of Surgery, Volume 93, Number 11, November 2006 , pp. 1418-1423(6)

Publisher: John Wiley & Sons, Ltd.

Abstract:

Background:

Most injured children are appropriately treated at a district general hospital (DGH), but some require transfer to a specialist centre. The objectives of this study were to develop, implement and evaluate triage guidelines for the rapid recognition of injured children who require transfer.

Methods:

This was a prospective, interventional cohort study of the 592 seriously injured children who presented to five regional DGHs during a 51-month period. A multispecialty steering group representing all participating DGHs developed and implemented the guidelines. Data were collected for 24 months before the guidelines were introduced, over the 3-month implementation period and for 24 months afterwards. Outcome measures were referral and management patterns before and after introduction of the guidelines.

Results:

For level I (unstable) patients, after the implementation of guidelines there was a 29 per cent increase in the proportion of transfers to a specialist centre (from 40 (68 per cent) of 59 to 32 (97 per cent) of 33; P = 0·003), no admissions to a DGH intensive care unit and all 12 operations were performed at a specialist centre. Guideline users indicated that they were familiar with the guidelines.

Conclusion:

The introduction of triage guidelines within an effective communication network was associated with changes in the management of severely injured children. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Document Type: Research article

DOI: http://dx.doi.org/10.1002/bjs.5356

Publication date: 2006-11-01

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