title: Developing a pediatric trauma system in Tuscany, Italy: a case study in transformative change.
abstract: BACKGROUND
  Trauma is the leading cause of death and disability in Italy among patients aged between 1 year and 19 years. To transform its fragmented regional pediatric trauma system to a more organized and efficient spoke and hub model, Tuscany has developed a partnership with physicians from the United States to facilitate the process and to implement a series of strategic system changes to create the first pediatric trauma center in Italy.
  
  
  METHODS
  After establishing a multidisciplinary and institutional task force, a rigorous needs assessment was conducted to evaluate resources and develop a strategic timeline with specific project goals. Once an intensive educational program was completed, a series of system changes were made in Tuscany to create a full-service pediatric trauma center. Once accomplished, regional changes were enacted to divert the most severely injured children to the new center.
  
  
  RESULTS
  In <3 years, a full-service pediatric trauma center was developed and ingratiated into the adult trauma system. All these changes were achieved through relentless administrative support, creation of a strong sense of urgency, and empowerment of innovators and early adopters to effect change.
  
  
  CONCLUSIONS
  Through a comprehensive process including early extensive system analysis leading to educational interventions and organizational changes, the Anna Meyer Children's Hospital has developed the first Italian pediatric trauma center.
authors: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. kban@bidmc.harvard.edu
authors: Kevin M
authors: KM
authors: Ban
authors: Francesco
authors: F
authors: Mannelli
authors: David P
authors: DP
authors: Mooney
authors: Simone
authors: S
authors: Lazzeri
authors: Leonardo
authors: L
authors: Bussolin
authors: Roger
authors: R
authors: Barkin
authors: Antonio
authors: A
authors: Messineo
authors: Stefano
authors: S
authors: Masi
authors: Monica
authors: M
authors: Frassineti
mesh_terms: D004635:Emergency Medicine / Q000193:education; D006801:Humans; D007318:Inservice Training; D007391:International Cooperation; D007558:Italy; D020380:Needs Assessment; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration; D010372:Pediatrics / Q000193:education / Q000458:organization & administration*; D010934:Planning Techniques; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States