Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department
Abstract Objective Cervical spine imaging decision‐making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergen...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.13024 |
| _version_ | 1797737280719290368 |
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| author | Megan E. Gregory Annie Truelove Fahd Ahmad Daniel Corwin Leah Tzimenatos Scott J. Oglesbee Martin J. Herman Julie C. Leonard |
| author_facet | Megan E. Gregory Annie Truelove Fahd Ahmad Daniel Corwin Leah Tzimenatos Scott J. Oglesbee Martin J. Herman Julie C. Leonard |
| author_sort | Megan E. Gregory |
| collection | DOAJ |
| description | Abstract Objective Cervical spine imaging decision‐making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department–trauma team dynamics may affect implementation of such a tool. Methods We interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision‐making process. Data were coded following a framework‐driven deductive coding process and thematic analysis was used. Results Forty‐eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I–III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision‐making process. Conclusions Implementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed. |
| first_indexed | 2024-03-12T13:26:23Z |
| format | Article |
| id | doaj.art-53fce1d2d8be41f9b5a3801d1cf02f72 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-03-12T13:26:23Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-53fce1d2d8be41f9b5a3801d1cf02f722023-08-25T05:44:30ZengWileyJournal of the American College of Emergency Physicians Open2688-11522023-08-0144n/an/a10.1002/emp2.13024Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency departmentMegan E. Gregory0Annie Truelove1Fahd Ahmad2Daniel Corwin3Leah Tzimenatos4Scott J. Oglesbee5Martin J. Herman6Julie C. Leonard7Department of Health Outcomes and Biomedical Informatics University of Florida GainesvilleFloridaUSAAbigail Wexner Research Institute at Nationwide Children's Hospital ColumbusOhioUSADivision of Emergency Medicine Department of Pediatrics Washington University in St. Louis School of Medicine St. LouisUSADivision of Emergency Medicine Department of Pediatrics Children's Hospital of Philadelphia PhiladelphiaPennsylvaniaUSADepartment of Emergency Medicine University of California Davis School of Medicine SacramentoCaliforniaUSADepartment of Emergency Medicine Division of Pediatric Emergency Medicine University of New Mexico Health Sciences Center AlbuquerqueNew MexicoUSASt. Christopher's Hospital for Children PhiladelphiaPennsylvaniaUSAAbigail Wexner Research Institute at Nationwide Children's Hospital ColumbusOhioUSAAbstract Objective Cervical spine imaging decision‐making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department–trauma team dynamics may affect implementation of such a tool. Methods We interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision‐making process. Data were coded following a framework‐driven deductive coding process and thematic analysis was used. Results Forty‐eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I–III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision‐making process. Conclusions Implementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.https://doi.org/10.1002/emp2.13024clinical decision supportimagingpediatric traumateamwork |
| spellingShingle | Megan E. Gregory Annie Truelove Fahd Ahmad Daniel Corwin Leah Tzimenatos Scott J. Oglesbee Martin J. Herman Julie C. Leonard Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department Journal of the American College of Emergency Physicians Open clinical decision support imaging pediatric trauma teamwork |
| title | Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department |
| title_full | Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department |
| title_fullStr | Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department |
| title_full_unstemmed | Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department |
| title_short | Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department |
| title_sort | decision making for pediatric cervical spine imaging after blunt trauma investigating team dynamics in the emergency department |
| topic | clinical decision support imaging pediatric trauma teamwork |
| url | https://doi.org/10.1002/emp2.13024 |
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