Standardizing the Evaluation of Nonaccidental Trauma in a Large Pediatric Emergency Department.

Abstract:

BACKGROUND AND OBJECTIVES:Variability exists in the evaluation of nonaccidental trauma (NAT) in the pediatric emergency department because of misconceptions and individual bias of clinicians. Further maltreatment, injury, and death can ensue if these children are not evaluated appropriately. The implementation of guidelines for NAT evaluation has been successful in decreasing differences in care as influenced by race and ethnicity of the patient and their family. Our Specific, Measurable, Achievable, Realistic, and Timely aim was to increase the percent of patients evaluated in the emergency department for NAT who receive guideline-adherent evaluation from 47% to 80% by December 31, 2016. METHODS:The team determined key drivers for the project and tested them by using multiple plan-do-study-act cycles. Interventions included construction of a best practice guideline, provider education, integration of the guideline into workflow, and order set construction to support guideline recommendations. Data were compiled from electronic medical records to identify patients <3 years of age evaluated in the pediatric emergency department for suspected NAT based on chart review. Adherence to guideline recommendations for age-specific evaluation (<6, 6-12, and >12-36 months) was tracked over time on statistical process control charts to evaluate the impact of the interventions. RESULTS:A total of 640 encounters had provider concern for NAT and were included in the analysis. Adherence to age-specific guideline recommendations improved from a baseline of 47% to 69%. CONCLUSIONS:With our improvement methodology, we successfully increased guideline-adherent evaluation for patients with provider concern for NAT. Education and electronic support at the point of care were key drivers for initial implementation.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Riney LC,Frey TM,Fain ET,Duma EM,Bennett BL,Murtagh Kurowski E

doi

10.1542/peds.2017-1994

subject

Has Abstract

pub_date

2018-01-01 00:00:00

issue

1

eissn

0031-4005

issn

1098-4275

pii

peds.2017-1994

journal_volume

141

pub_type

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