Recognizing Nonaccidental Trauma in a Pediatric Tertiary Hospital: A Quality Improvement Imperative.

Autor:	Greene HM; Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and the Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio.; Division of Child Abuse Pediatrics, Department of Pediatrics, The Ohio State University College of Medicine, and the Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio., Letson MM; Division of Child Abuse Pediatrics, Department of Pediatrics, The Ohio State University College of Medicine, and the Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio., Spencer SP; Section of Emergency Medicine, Children's Hospital Colorado, and Department of Pediatrics University of Colorado School of Medicine, Aurora, Colorado., Dolan K; Department of Quality Improvement, Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio., Foster J; Department of Clinical Medical Social Work, The Ohio State University College of Social Work, and the Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio., Crichton KG; Division of Child Abuse Pediatrics, Department of Pediatrics, The Ohio State University College of Medicine, and the Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio.
Jazyk:	angličtina
Zdroj:	Pediatric quality & safety [Pediatr Qual Saf] 2023 Apr 10; Vol. 8 (2), pp. e644. Date of Electronic Publication: 2023 Apr 10 (Print Publication: 2023).
DOI:	10.1097/pq9.0000000000000644
Abstrakt:	Abusive injuries can go unrecognized or improperly managed by medical providers. This study sought to standardize the nonaccidental trauma (NAT) workup and improve NAT evaluation completion for children <7 months with concerning injuries in the pediatric emergency department (PED) and inpatient settings at an urban, tertiary care children's hospital. Methods: The quality improvement (QI) team created hospital guidelines for suspected NAT, including age-based recommendations (care bundle). The team embedded an order for NAT evaluation into the electronic health record (EHR). The QI team provided education on child abuse identification and evaluation across the hospital. Hospital providers received written guides focused on enhancing communication with families. Outcome measures included monthly NAT bundle use and cases between incomplete bundles in children with suspicious injuries. Chart review of incomplete bundles helped accurately identify patients who needed NAT bundles and improved accurate NAT bundle completion for appropriate patients. Results: Appropriate NAT bundle completion increased from 31% during the baseline period in January 2019 to 100% in April 2020 and remained at 100% for the remainder of the study period, ending June 2021. The number of patients between missed bundles was 11 from August 2019 until March 2020, when it increased to 583. There were no missed bundles from March 2020 through June 2021. Conclusions: Standardizing NAT evaluation and creating a NAT care bundle to facilitate the appropriate evaluation preceded an increase in appropriate bundle completion in patients <7 months old with possible NAT in the PED and inpatient units. Competing Interests: The authors have no financial interest to declare in relation to the content of this article. (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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