Pediatric Trauma Performance Improvement/Outreach Coordinator

University of Rochester•City of Rochester, NY
•$73,528 - $99,257•Onsite

About The Position

The Pediatric Trauma Performance Improvement (PI) Coordinator is responsible for the coordination, execution, and ongoing development of the trauma performance improvement and patient safety (PIPS) program within the Pediatric Surgery Division within the Department of Surgery. This role ensures continuous monitoring, identification, investigation, and resolution of deviations in care, with a focus on loop closure, regulatory compliance, and optimal patient outcomes. The PI coordinator will serve as Quality Assurance Liaison on behalf of the Pediatric Trauma Program to the Department of Surgery and Hospital Quality Office. The Pediatric PI coordinator will also be responsible for planning, implementing, and executing Pediatric Trauma Outreach events/activities. Under the direction of the Pediatric Trauma Medical Director and Pediatric Trauma Program Manager, the PI Coordinator will work collaboratively with multidisciplinary clinical teams, Hospital Quality Office, and Departmental/Divisional Quality Teams to ensure adherence to standards set forth by the University of Rochester Medical Center, American College of Surgeons, New York State Department of Health, Joint Commission, and other regulatory offices.

Requirements

  • Bachelor's degree in Nursing and 4 years clinical nursing experience, including 1 year of experience with clinical chart review, monitoring of clinical data and process improvement required
  • Or equivalent combination of education and experience
  • Registered Nurse (RN) licensed in New York State (NYS) upon hire required

Nice To Haves

  • Clinical experience in perioperative nursing, inpatient surgical unit, or surgical clinic preferred
  • Quality improvement or patient safety knowledge and experience preferred
  • Clinical experience in pediatric inpatient, pediatric intensive care, or pediatric emergency nursing preferred
  • Three (3) years of clinical chart review, performance improvement preferred, and/or
  • Performance improvement or quality assurance experience at ACS Level 1 trauma Center preferred
  • Five (5) years in pediatric clinical nursing in emergency department or inpatient unit trauma service preferred
  • Supervisory/management experience in clinical setting preferred
  • Statistical knowledge preferred
  • Clinical chart review and abstraction experience preferred
  • Quality Assurance and Process Improvement (QA/PI) experience preferred
  • Strong data analysis and interpretation skills preferred
  • Clinical Nurse Specialist (CNS) preferred
  • Trauma Certified Registered Nurse (TCRN) preferred
  • Advanced Trauma Certified Nurse (ATCN) preferred
  • Trauma Nursing Core Course (TNCC) preferred
  • Certified Pediatric Emergency Nurse (CPEN) preferred
  • Critical Care Registered Nurse (CCRN) preferred

Responsibilities

  • Coordinate and manage the Pediatric Trauma PIPS Program in accordance with American College of Surgeons (ACS) Resources for Optimal Care of the Injured Patient standards and Hospital Quality Office.
  • Utilize the Pediatric Trauma Registry and other data sources to identify individual cases requiring further review using audit filters, complications, and event triggers.
  • Ensure timely primary case review, secondary review, and escalation as needed.
  • Utilize the Pediatric Trauma Registry and other data sources to track and trend audit filters, complications, and event triggers to identify patterns and trends in care delivery.
  • Implement data-driven, evidence-based quality initiatives in coordination with the Pediatric Trauma Medical Director and Pediatric Trauma Program Manager.
  • Utilize ACS Trauma Quality Improvement Program (TQIP) benchmarking reports to analyze trauma center outcomes and aid in prioritization of performance improvement activities and projects.
  • Monitor effectiveness of quality initiatives and interventions post-implementation and escalate unresolved issues as necessary.
  • Work with the Pediatric Trauma Medical Director and Pediatric Trauma Program Manager to create and implement policies and procedures based on evidence-based, best practice to optimize patient care.
  • Serve as Quality Assurance Liaison on behalf of the Pediatric Trauma Program to Department of Surgery, which will assume the following responsibilities: Oversight and management of RL Solutions for pediatric trauma patients.
  • Participation in divisional, departmental, and hospital quality committees as appropriate to the Pediatric Trauma Program.
  • Support and participation in divisional, departmental, and hospital quality initiatives as appropriate to the Pediatric Trauma Program.
  • Participation in Root Cause Analysis process when applicable to the Pediatric Trauma Program.
  • Participate in Pediatric Trauma Program verification.
  • Performs chart review on individual cases to identify opportunities for improvement to enhance patient outcomes and complete PIPS documentation, including event resolution with loop closure, for all individual case reviews as required by ACS, Department of Surgery, and Hospital Quality Office.
  • Maintain PIPS database, quality dashboards, and audits.
  • Provide routine data reports to Pediatric Trauma Program leadership, Department of Surgery, and multidisciplinary trauma committees and teams as requested.
  • Will maintain ongoing collaboration with Trauma Registrars to define PIPS audit filters, complications, and event triggers to ensure consistent, accurate PIPS data capture within Trauma Registry.
  • Maintain required documentation required for ACS trauma verification visit, as directed by the Pediatric Trauma Medical Director and Pediatric Trauma Program Manager.
  • Support research activities of the Pediatric Trauma Program by providing access to and assistance with analysis of relevant data, as directed by Pediatric Trauma Medical Director and Pediatric Trauma Program Manager.
  • Provide routine reports on Pediatric Trauma Clinical Practice Guideline compliance.
  • Facilitate and support PIPS meetings with multidisciplinary teams to identify opportunities for improvement within pediatric trauma patient care, processes, and/or systems.
  • Lead multidisciplinary teams in implementing PIPS initiatives pertaining to the care of the injured patient, in coordination with the Pediatric Trauma Medical Director and the Pediatric Trauma Program Manager.
  • With the Pediatric Trauma Program Manager and Medical Director - responsible for creation of agenda and completion of meeting minutes for bi-monthly trauma multidisciplinary trauma peer review and trauma systems operational committee meetings.
  • Coordinate interdepartmental case reviews and ensure timely response and follow up.
  • Provide thorough communication of PIPS findings and follow up actions with all involved multidisciplinary teams.
  • Will represent the Pediatric Trauma Program in, local, regional, state, and national meetings.
  • Plan, implement, and coordinate pediatric trauma outreach events and activities.
  • Participate in community outreach and education activities under the direction of the Pediatric Trauma Medical Director and Pediatric Trauma Program Manager.
  • In collaboration with Trauma Service Nurse Educator, provide education on PIPS initiatives, trends, and opportunities to providers involved with the care of the injured patient.
  • Actively participate in the preparation for and in the site visit for ACS trauma center verification.
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