Examining emergency department treatment processes in severe pediatric traumatic brain injury

Ali Ajdari, Linda Ng Boyle, Nithya Kannan, Ali Rowhani-Rahbar, Jin Wang, Richard Mink, Benjamin Ries, Mark Wainwright, Jonathan I. Groner, Michael J. Bell, Chris Giza, Douglas F. Zatzick, Richard G. Ellenbogen, Pamela H. Mitchell, Frederick P. Rivara, Monica S. Vavilala

Research output: Contribution to journalArticlepeer-review


Background: In the treatment of pediatric traumatic brain injury (TBI), timely treatment of patients can affect the outcome. Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes. Methods: Data for 136 pediatric trauma patients (age, 18 years) with severe TBI from 2 trauma centers in the United States were collected. A process flow and value stream map identified NVATs and their sources in the treatment process. Cluster and regression analysis were used to examine the relationship between NVAT, as a percentage of the patient's length of stay (LOS), and the patient outcome, measured by their corresponding Glasgow outcome scale. Results: There were 14 distinct sources of NVAT identified. A regression analysis showed that increased NVAT was associated with less favorable outcomes (relative ratio = 1.015, confidence interval = [1.002-1.029]). Specifically, 1% increase in the NVAT-to-LOS ratio was associated with a 1.5% increase in the chance of a less favorable outcome (i.e., death or vegetative state). Conclusion: The NVAT has a significant impact on the outcome of pediatric TBI, and every minute spent on performing non-value-added processes can lead to an increase in the likelihood of less favorable outcomes.

Original languageEnglish (US)
Pages (from-to)334-344
Number of pages11
JournalJournal for Healthcare Quality
Issue number6
StatePublished - 2017


  • Healthcare
  • Non-value-added time
  • Pediatrics
  • Regression analysis
  • TBI

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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