|
Citation
|
Tiyyagura G, Emerson B, Gaither JR, Bechtel K, Leventhal JM, Becker H, Della Guistina K, Balga T, Mackenzie B, Shum M, Shapiro ED, Auerbach M, McVaney C, Morrell P, Asnes AG. Acad. Emerg. Med. 2020; ePub(ePub): ePub. |
|
Abstract
|
OBJECTIVE: Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In 3 CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children <12-months-old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months.
METHODS: We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from non-abusive injuries and felt a second opinion would help. Using a Plan-Do-Study-Act approach, beginning in April 2018 we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15-months prior and 17-months post-initiation of interventions. We used a statistical process control chart to track CPT consultations about children <1-year-old with high-risk injuries, use of skeletal surveys and reports to child protective services.
RESULTS: Evidence of special cause indicating sustained improvement was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8-month period, the CPT was consulted for a mean of 47.5% of children with high-risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high risk injuries who received a skeletal survey increased from 6.7% to 18.9% and who were reported to child protective services increased from 10.7% to 32.6%.
CONCLUSION: Targeted interventions in CEDs increased the frequency of CPT consultation, skeletal survey use and reports to child protective services for infants with high-risk injuries. Such interventions may improve recognition of physical abuse.
Language: en |