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Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency
Niti Shahi, Maxene Meier1, Marina L Reppucci2
1The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, CO.
Insights
Routine screening for child physical abuse in emergency departments (EDs) effectively identifies at-risk children. This vital screening process does not negatively impact ED workflow or patient length of stay.
Area of Science:
- Pediatrics
- Emergency Medicine
- Child Abuse Prevention
Background:
- Physical abuse is a major cause of child morbidity and mortality.
- Early recognition through routine screening in emergency departments (EDs) is proposed but its workflow impact is unknown.
Purpose of the Study:
- To assess the feasibility of routine child physical abuse screening in general EDs.
- To evaluate the impact of this screening on ED workflow, specifically length of stay.
Main Methods:
- A 2-question screening tool was implemented for children under 6 years old across 27 general EDs.
- Data were compared for 6 months pre- and post-implementation, analyzing ED length of stay.
Main Results:
- Screening was completed in 78.9% of eligible visits, with 0.7% screening positive.
- Mean ED length of stay remained statistically unchanged (95.9 vs. 95.2 minutes).
- Screening did not significantly affect resource utilization or overall ED length of stay.
Conclusions:
- Routine physical abuse screening is feasible and identifies high-risk children without increasing ED length of stay or resource use.
- Future research should examine rates of subsequent serious physical abuse in screened versus unscreened children.
Objectives:
Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs.
Methods:
A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes.
Results:
There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods.
Conclusions:
Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
