Determining the priorities for change in paediatric trauma care delivery in NSW, Australia

Professor Kate Curtis1,2,3,4, Ms Belinda Kennedy1, Professor Andrew  Holland1,5, Associate Professor Rebecca Mitchell6, Dr Gary Tall7, Dr Holly Smith8, Dr Soundappan SV Soundappan1,5, Mr Allan Loudfoot7, Dr Brian Burns7, Associate Professor  Michael Dinh9,10

1The University Of Sydney, Camperdown, Australia, 2Illawarra Shoalhaven Local Health District, , Australia, 3The George Institute for Global Health, Sydney, Australia, 4Illawarra Health and Medical Research Institute, Wollongong, Australia, 5The Children’s Hospital at Westmead, Australia, 6Australian Institute of Health Innovation, Maquarie University, , Australia, 7NSW Ambulance, Rozelle, Australia, 8Northern Sydney Local Health District, Australia, 9NSW Institute of Trauma and Injury Management, Chatswood, Australia, 10Sydney Local Health District, Australia

Background: In Australia, injury remains the leading cause of death and disability for children and there is known variability in the quality of care delivered to injured children.  In 2018 an expert peer-review of 535 major paediatric trauma cases in New South Wales was undertaken using a validated clinical, system and human factors peer-review tool. This multidisciplinary review identified contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change.  This study prioritises these recommendations for implementation with the aim of improving health service delivery to severely injured children.

Methods: A modified-Delphi study was conducted between October 2018 and February 2019. Two rounds of an online survey to rank the suitability and importance of each of the 26 recommendations was conducted. Final decisions on the priorities for change in the paediatric trauma system was determined by a consensus of ≥80% for importance and/or suitability.

A range of key stakeholders from across NSW including clinicians and health service administrators, consumers and government representatives participated.

Results: One hundred and one participants completed Round 1, and 60 participants completed Round 2 of the modified-Delphi. In Round 1, 13 recommendations reached ≥80% and in round 2, 11 recommendations reached ≥80%. Those ranked highest focussed on pre-hospital airway management, streamlining retrieval and transfer processes, improving hospital nursing ratios and radiology reporting.

Conclusion: The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria, performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.


Professor Kate Curtis has been an Emergency Nurse since 1994 and is Clinical Nurse Consultant for Emergency at Illawarra Shoalhaven Local Health District. Kate is Professor of Emergency and Trauma Nursing at the University of Sydney and an honorary professorial fellow at the George Institute for Global Health. Kate’s translational research program focuses on improving the way we deliver care to patients and their families, and has attracted more than $4 million funding. Kate is the world’s most published author in the field of Trauma and Emergency Nursing and has mentored more than 40 clinicians in research projects.