Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering methods, we combine interview, archival document, and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e., safety in complex systems. We discuss three levels of awareness (individual, team, and organizational), and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration, and decision-making. A challenge to team awareness is inadequate “non-technical” skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, using process modeling or simulation.

中文翻译：

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儿科创伤护理过程的复杂性：对多层次意识的影响

创伤是美国儿童和年轻人残疾和死亡的主要原因。虽然对住院儿科创伤护理的医学方面了解很多，但对住院护理所涉及的过程和作用却知之甚少。使用人因工程方法，我们结合访谈、档案文件和创伤登记数据来描述院内护理转换如何影响流程和团队复杂性。具体而言，我们确定了每个医院单元中直接参与患者护理的 53 个角色，并描述了医院单元之间的 3324 次总转换以及儿科创伤患者经历的从到达到出院的 69 条独特途径。我们继续争论从消除复杂性转向应对复杂性，并建议支持三个层次的意识，以增强医疗保健中患者安全所需的弹性和适应能力，即复杂系统中的安全。我们讨论了意识的三个层次（个人、团队和组织），并描述了每个层次的挑战和潜在的社会技术解决方案。例如，对个人意识的挑战之一是高时间压力。一个潜在的解决方案是信息感知、集成和决策的临床决策支持。对团队意识的挑战是“非技术”技能不足，例如领导力、沟通、角色清晰度；模拟或其他形式的培训可以改善这些。这个过程的复杂、分布式特性对组织意识是一个挑战；