Protocol Development for an Emergency Department at an Urban Utah Hospital

Pediatric head trauma protocols have been shown to decrease unnecessary imaging for patients being evaluated for a head trauma in the emergency department. The purpose of this project was to assess the current imaging and treatment practices of the providers at an urban medical center and to develop a pediatric head trauma protocol for this facility to be integrated into the health care electronic health record (EHR) of the healthcare facility. Information regarding imaging practices and provider protocol preferences for evaluating head trauma in children were identified through the use of provider surveys to query providers about current practices and guiding protocols for managing head trauma. A retrospective chart review was completed (n=117) to analyze the current medical decision-making practices of providers. A pediatric head trauma protocol was developed and presented to stakeholders for feedback and approval. Finally, a smart phrase incorporating the protocol was developed for integration into the EHR at the project implementation site. The Pediatric Emergency Care Applied Research Network (PECARN) protocol was the protocol most frequently used by providers who were surveyed. However, this was not always documented in the notes of charts reviewed. Concerns regarding the lack of physician discretion and fears of increased liability if there was deviation from the protocol were identified during presentation of the protocol draft. Ease of integration of the protocol in the EHR to guide practice was also debated. The protocol was approved by the providers and submitted to administration to begin the approval and adoption process. Once adopted, further study will be necessary to evaluate whether use of the protocol reduces head imaging among pediatric patients seen at the facility for head trauma.