JMIR Publications

ABSTRACT

Background:

Care of pediatric trauma patients is delivered by multidisciplinary care teams with high fluidity that may vary in composition and organization depending on time of day.

Objective:

To identify and describe diurnal variations in multidisciplinary care teams taking care of pediatric trauma patients using social network analysis on electronic health record (EHR) data.

Methods:

Metadata of clinical activities were extracted from the EHR and processed into an event log, which was divided into six different event logs based on shift (day or night) and location (emergency department [ED], pediatric intensive care unit [PICU], and floor). Social networks were constructed from each event log by creating an edge between functional roles captured within similar time interval during a shift. Overlapping communities were identified from the social networks. Day and night network structures for each care location were compared and validated via comparison to (1) secondary analysis of qualitatively derived care team data, obtained through semi-structured interviews; and (2)member checking interviews with clinicians.

Results:

There were 413 encounters in the one-year study period with 272 (65.9%) and 141 (34.1%) beginning during day and night shifts, respectively. A single community was identified at all locations during the day, and in the PICU at night, while multiple communities corresponding to individual specialty services were identified in the ED and on the floor at night. Members of the trauma service belonged to all the communities, suggesting they were responsible for care coordination. Healthcare professionals found the networks to be largely accurate representations of the composition of the care teams and the interactions among them.

Conclusions:

Social network analysis was successfully employed on EHR data to identify and describe diurnal differences in composition and organization of multidisciplinary care teams at a pediatric trauma center.