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Abstract
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In this issue of Pediatrics, Hansen et al1 present a hospital-based patient safety program to identify children for whom there is a concern for or suspicion of child maltreatment. Rationale for such a safety program is supported by the high prevalence of child maltreatment,2 likelihood of recurrence without recognition and reporting,3 subtlety of clinical presentations, and physician reluctance and lack of confidence in assessing and diagnosing child maltreatment.4
Although recognition of clinical presentations that may indicate maltreatment can be facilitated through hospital policies and various trainings, clinician uptake may be variable and inconsistent. In addition, managing suspected abuse or neglect involves a report to Child Protective Services and the possibility of separating the child from the family. This is the antithesis of pediatric practice for many clinicians, so this decision to report is understandably difficult. Yet the stakes are significant and include not reporting suspected abuse in a child who returns with another injury (or worse), as well as reporting suspected abuse in a child who is later determined to have a medical condition that explains their clinical findings. Even when maltreatment is suspected, medical errors can occur if diagnostic testing is incomplete or critical information from investigators or caregivers is not solicited. A system-wide safety program removes some of the uncertainties and angst by implementing an intermediate measure that allows for additional information to be gathered and analyzed to determine the best next steps.
In their study, Hansen et al1 detail a system-wide program in a large pediatric health care system encompassing both inpatient and outpatient settings. The intermediate measure is expensive in terms of resources and time: 24/7 availability of a social worker who conducts an in-person assessment and completion of a patient at risk (PAR) form and availability of a child abuse team to review every PAR form within 24 hours. But the outcomes appear to be worth the expense: nearly 27% of the 7698 PARs required further interventions by the child abuse team, and of these, 53 required immediate interventions because of potential diagnostic errors and concerns about child safety. This safety intervention appears to be an effective bridge...
Language: en |