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

Area of Science:

• Pediatric Emergency Medicine
• Child Abuse Pediatrics
• Quality Improvement Science

Background:

• Abusive injuries in children are often missed or inadequately managed by healthcare providers.
• Standardized protocols are needed to improve the identification and evaluation of nonaccidental trauma (NAT) in young children.
• Existing evaluation processes for suspected NAT may lack consistency, leading to potential gaps in care.

Purpose of the Study:

• To standardize the nonaccidental trauma (NAT) workup for children under 7 months old presenting with concerning injuries.
• To improve the completion rate of NAT evaluations in pediatric emergency departments and inpatient settings.
• To implement a care bundle approach for evaluating suspected child abuse in a pediatric hospital.

Main Methods:

• A quality improvement team developed hospital guidelines and an age-based care bundle for suspected NAT.
• An electronic health record (EHR) order for NAT evaluation was embedded into clinical workflows.
• Education on child abuse identification and evaluation was provided to hospital staff, along with communication guides for families.

Main Results:

• Appropriate NAT bundle completion increased from 31% (baseline) to 100% by April 2020, sustained through June 2021.
• The number of patients with missed NAT bundles decreased significantly after implementation.
• The standardized approach led to consistent and complete NAT evaluations for eligible pediatric patients.

Conclusions:

• Standardizing NAT evaluations through a dedicated care bundle effectively increased appropriate evaluation completion in young children.
• The implemented quality improvement initiative successfully addressed gaps in NAT evaluation processes.
• This approach enhances the detection and management of abusive injuries in pediatric care settings.