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Simple intervention to improve detection of child abuse in emergency departments
1Emergency Department, Frenchay Hospital, Bristol BS16 1LE.
Insights
A simple reminder flowchart significantly improved the documentation and consideration of child abuse in emergency departments. This tool enhanced awareness and vigilance among healthcare providers for injured preschool children.
Area of Science:
- Pediatrics
- Emergency Medicine
- Child Protection
Background:
- Child abuse is often missed in fast-paced emergency departments.
- Injured preschool children are a vulnerable population requiring careful assessment.
- Suburban teaching hospitals manage a high volume of pediatric emergency cases.
Purpose of the Study:
- To evaluate the effectiveness of a reminder flowchart in improving the identification of child abuse.
- To assess the impact of a new protocol on documentation and referral rates for suspected child abuse.
- To enhance awareness and vigilance regarding intentional injuries in young children.
Main Methods:
- A two-stage audit was conducted on 1000 children before and after implementing a reminder flowchart.
- Nurses used the flowchart for children aged 0-5 with any injury, documenting intentional injury indicators.
- Data collected included documentation of intentional injury and referral for assessment.
Main Results:
- Documentation of intentional injury indicators increased significantly after flowchart implementation.
- Compatibility of history with injury and consistency of history improved from less than 2% to over 70%.
- Referral rates for further assessment showed an upward trend, indicating increased vigilance.
Conclusions:
- A simple reminder flowchart is effective in increasing awareness, consideration, and documentation of intentional injury in emergency settings.
- The use of such tools can lead to improved identification and management of child abuse cases.
- Enhanced vigilance was observed even in cases not directly using the flowchart, suggesting broader impact.
Problem:
Child abuse is easily overlooked in a busy emergency department.
Design:
Two stage audit of 1000 children before and after introduction of reminder flowchart.
Background And Setting:
An emergency department in a suburban teaching hospital seeing about 4000 injured preschool children a year.
Key Measures For Improvement:
Number of records in which intentional injury was adequately documented and considered and the number of children referred for further assessment before and after introduction of reminder flowchart into emergency department notes.
Strategies For Change:
Nurses were asked to insert a reminder flowchart for assessing intentional injury into the notes of all children aged 0-5 years attending the department with any injury and to record the results of checking the child protection register. EFFECT OF CHANGE: Documentation of all eight indicators that intentional injury had been considered had increased in the second audit. Records of compatibility of history with injury and consistency of history increased from less than 2% to more than 70% (P<0.0001). More children were referred for further assessment in the second audit than the first, although the difference was not significant (6 (0.6%) v 14 (1.4%), P=0.072). The general level of awareness and vigilance increased in the second audit, even for children whose records did not contain the flowchart.
Lessons Learnt:
Inclusion of a simple reminder flowchart in the notes of injured preschool children attending the emergency department increases awareness, consideration, and documentation of intentional injury. Rates of referral for further assessment also increase.