Identifying Barriers to Pediatric Trauma Resuscitation: A Cross-Disciplinary Needs Assessment and Evidence-Informed Quality Improvement Framework

Background/Objectives: Pediatric trauma resuscitation requires rapid, coordinated interdisciplinary teamwork; however, communication and organizational challenges frequently impede effective performance. This study aimed to characterize cross-disciplinary perceptions of barriers encountered during pediatric trauma activations and to contextualize these findings within an evidence-based quality improvement framework. Methods: We conducted a single-center, cross-sectional, anonymous electronic survey at a Level II pediatric trauma center within a tertiary adult hospital. Participants included attending and resident physicians, nurses, respiratory therapists, technicians, and ancillary staff involved in pediatric trauma activations. A 22-item survey assessed leadership, audibility, closed-loop communication, role clarity, crowding, and overall coordination. Descriptive statistics summarized responses, and free-text responses were reviewed thematically. Results: Sixty-seven team members responded (attending physicians n = 12, residents n = 15, nurses n = 22, respiratory therapists/technicians n = 18). Overall, 82% reported that crowding interfered with resuscitations, while only 6% rated leaders as very effective at managing crowding. Difficulty hearing the team leader (60%) and peers (66%) was common. Roles were always defined for 16% of respondents, and consistent use of closed-loop communication was reported by 24%; 3% were unfamiliar with the concept. More than half of respondents (54%) reported excessive personnel during activations. Conclusions: Pediatric trauma team members identified crowding, poor audibility, role ambiguity, and inconsistent structured communication as barriers to effective resuscitation. These findings support targeted quality improvement strategies, including team-size management, reinforcement of closed-loop communication, checklist use, and recurring in situ simulation with structured debriefing.