title: Development of a pediatric Level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation.
abstract: BACKGROUND
  Despite research correlating survival or better outcomes with pediatric trauma care at pediatric hospitals, almost 90% of injured children are treated at predominantly adult facilities. Although the reasons are likely multifactorial, attitudes of pediatric hospital staff may play a role in the development of a pediatric trauma center.
  
  
  METHODS
  A survey of hospital staff was conducted to measure the attitude of staff on the effects of becoming a pediatric trauma center. The instrument was administered before and 6 months after trauma center designation. Major topic areas were staffing, organizational impact, education, safety, and financial issues. Attitudes were measured by Likert scale and compared between phases.
  
  
  RESULTS
  A total of 404 staff participated before and 447 staff participated 6 months after designation. Nonphysician respondents dominated the survey respondent pool. Areas of concern included staffing, education, patient volume and acuity, and order and flow. Positive attitudes were seen in areas including quality of care, skill development, and recruitment. Overall improvement in attitudes was observed in several areas.
  
  
  CONCLUSIONS
  Hospital staff consistently agreed on the positive impact on quality of care and overall employee benefit. Concerns were mostly diminished at follow-up. A persistent concern of adequate staffing mismatched actual needs. The findings of this study indicate that the staff perceive many measurable benefits to pediatric trauma center development, which have never previously been described.
authors.affiliation: Institutional Level 1 Pediatric Trauma Center and Center for Injury Prevention, Phoenix Children's Hospital, Phoenix, AZ 85006, USA. dnotrica@surgery4children.com
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.forename: Deb
authors.initials: D
authors.lastname: Brown
authors.forename: Pamela
authors.initials: P
authors.lastname: Garcia-Filion
mesh_terms: D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002648:Child; D006776:Hospitals, Pediatric; D006801:Humans; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000145:classification* / Q000458:organization & administration*