584 - Collaborative Quality Improvement Between a Children's Hospital and an Adult Level I Trauma Center to Reduce Multifacility Pediatric Trauma Transfers in East Tennessee

Publication Number: 1561.584

Oseana Bratton, East Tennessee Children's Hospital, Knoxville, TN, United States; Frankie Crain-Ruf, East Tennessee Children's Hospital, Knoxville, TN, United States; Suzanne Rybczynski, East Tennessee Children's Hospital, Knoxville, TN, United States; C. Lindsay McKnight, University of Tennessee Health Science Center College of Medicine, Knoxville, TN, United States; Ryan Redman, East Tennessee Children's Hospital, Knoxville, TN, United States; Dani Crowe, University of Tennessee Medical Center, Knoxville, TN, United States; Christy L. Cooper, East Tennessee Children’s Hospital, Blaine, TN, United States; Karen L.. Burchfield, DNP, MSN, RN, CPN, ETCH, Knoxville, TN, United States

Background: Multiple interfacility transfers result in inefficient utilization of scarce pediatric trauma and transport resources, reduce patient and caregiver satisfaction, and may contribute to clinically significant delays in definitive care. The pediatric trauma system in East Tennessee is composed of a Level I adult trauma center (University of Tennessee Medical Center Knoxville [UTMCK]), a free-standing pediatric hospital (East Tennessee Children's Hospital [ETCH]), and 29 outlying community hospitals, serving 22 counties. Historically, transfer patterns frequently resulted in unnecessary multi-facility transfers (MFTs) involving two or more transitions in care. The purpose of this quality improvement initiative was to decrease the proportion of patients who did not require Level I trauma resources at UTMCK and who were clinically appropriate for direct transfer from referring hospitals to ETCH. Prior to the project, the annual average of patients requiring MFTs was 29%.

Objective: The goal of this project was to reduce the proportion of pediatric trauma patients requiring MFTs from by half within 12 months.

Design/Methods: A multidisciplinary stakeholder workgroup was convened by ETCH and UTMCK to identify modifiable system-level contributors to unnecessary transfers. See Key Driver Diagram. All regional pediatric trauma referrals were subsequently routed through a single access point call center housed at ETCH, where Level I trauma resource utilization was determined in real time. In addition, shared radiographic imaging access was expanded to optimize clinical decision-making, and a targeted educational outreach campaign to referring hospitals was implemented to clarify revised transfer expectations. The unified call center strategy launched January 1, 2025. Outcome measures were evaluated quarterly (Image 1).

Results: From 2023 to Quarter 2 of 2025, there was a total of 1,446 pediatric trauma patients; 64 required MFTs. (Table 2 summarizes demographic and clinical variables.) After implementation, the proportion of patients requiring MFTs decreased from 29% to 10% through the first three quarters of 2025 based on preliminary Quarter 3 data.

Conclusion(s): Cross-system collaboration and a centralized access point for pediatric trauma referrals resulted in a marked reduction in unnecessary MFTs across the region. Use of a single call center to triage non-Level I candidates improved accuracy of disposition to the most appropriate facility. Sustained adherence to this approach is critical to ensure pediatric patients consistently receive the correct level of care at the earliest point in their trauma trajectory.

Key Driver Diagram
Multiple opportunities for improvement were identified, many centering around exchange of information

Pediatric Trauma Multifacility Transfers
Total pediatric trauma patients shared by UTMCK and ETCH broken down into direct transfer and multifacility transfers, shown both quarterly and annually.

Pediatric Trauma Patients Pertinent Demographics and Clinical Category
Demographic information for pediatric trauma transfers (age range, patient origin, referring facility type) over 3 years are demonstrated in the upper table. The lower table reveals number of handoffs for those shared between UTMCK and ETCH, which specialty category the primary trauma falls into, and injury severity score.