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

Area of Science:

• Pediatric Emergency Medicine
• Clinical Quality Improvement
• Child Abuse and Neglect

Background:

• Variability in nonaccidental trauma (NAT) evaluations in pediatric emergency departments stems from clinician bias and misconceptions.
• Inconsistent evaluations can lead to further harm, injury, or death in children.
• Existing guidelines have shown success in reducing care disparities related to race and ethnicity.

Purpose of the Study:

• To increase guideline-adherent evaluations for suspected nonaccidental trauma (NAT) in pediatric emergency departments.
• The specific aim was to raise adherence from 47% to 80% by December 31, 2016.
• To reduce variability and improve the quality of care for children undergoing NAT evaluation.

Main Methods:

• Utilized plan-do-study-act cycles to identify and test key drivers for improving NAT evaluations.
• Implemented interventions including a best practice guideline, provider education, workflow integration, and electronic order sets.
• Tracked adherence to age-specific NAT evaluation guidelines using electronic medical records and statistical process control charts for patients under 3 years old.

Main Results:

• A total of 640 patient encounters with provider concern for NAT were analyzed.
• Adherence to age-specific guideline recommendations for NAT evaluation improved significantly from a baseline of 47% to 69%.
• The improvement methodology demonstrated a measurable increase in guideline-adherent care.

Conclusions:

• The implemented improvement methodology successfully enhanced guideline-adherent evaluations for suspected nonaccidental trauma (NAT).
• Provider education and electronic decision support at the point of care were critical for successful intervention implementation.
• The study highlights the effectiveness of systematic approaches in standardizing care for vulnerable pediatric populations.