Applying Community Based System Dynamics to Examine Pediatric Mild Traumatic Brain Injury Workflow in the Emergency Department

Wednesday, July 30, 2025, 6:25 AM

Session: Poster Session (Morning, 30th of July)

Despite validated clinical decision support tools and evidence supporting guideline-based care, adherence to best practices for evaluating children with mild traumatic brain injury (mTBI) in the Emergency Department (ED) remains inconsistent. To explore this gap, we engaged emergency medicine (EM) clinicians in a community-based system dynamics (CBSD) session focused on care delivery for children with mTBI. We aimed to understand structural, site-specific factors contributing to workflow delays in information transfer and decision-making when caring for children with mTBI and identify key components of potential implementation strategies that address these delays. The CBSD facilitation manual included scripts for icebreaking, eliciting variables within the system, deliberating on how variables are connected, and voting on the most important variables. Among 8 workshop participants, 2 were pediatric EM clinical fellows, and 6 were pediatric EM attendings. The resulting causal loop diagram highlighted several relevant system-level factors clinicians consider while managing children with mTBI including the role of trust, patient volume, provider variability, and family expectations. The application of CBSD was an innovative and effective approach for assessing ED context related to mTBI care. Insights from this process will inform best practices for implementing evidence-based guidelines for children with mTBI within the ED.