A System-Wide Hospital Child Maltreatment Patient Safety Program.

Area of Science:

• Pediatrics
• Public Health
• Patient Safety

Background:

• Hospital patient safety programs are established but not widely applied to child maltreatment.
• Child maltreatment poses a significant public health concern requiring systematic identification and intervention within healthcare settings.

Purpose of the Study:

• To describe a hospital-system child maltreatment safety program.
• To characterize the frequency of patients needing intervention for child maltreatment.
• To identify factors associated with the need for intervention, including patient age, location of care, and immediate intervention requirements.

Main Methods:

• A patient at risk (PAR) form was utilized for all staff concerns regarding child maltreatment.
• Social workers completed PAR forms, reviewed within 24 hours by a child abuse team.
• Interventions were categorized, with statistical analyses (Wilcoxon rank and chi-squared tests) used for comparisons.

Main Results:

• Over 30 months, 26.8% of 7698 PAR forms led to interventions, with physical abuse being the most common reason (32.5%).
• Patients requiring intervention did not differ significantly in age from those who did not.
• PAR forms from emergency departments or urgent care were more likely to necessitate intervention compared to inpatient or clinic settings.

Conclusions:

• A health system's child maltreatment safety program can successfully identify and address medical errors.
• The program demonstrated effectiveness in flagging cases requiring further action, particularly in acute care settings.
• Immediate interventions and follow-up in specialized clinics led to new or changed diagnoses in a significant proportion of cases.