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Increasing a hospital-based violence intervention program's referrals for children and families in a pediatric
Narmeen I Khan1,2, Sri S Chinta3, Brooke M Cheaton4
1Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, Milwaukee, WI, 53226, USA. nikhan@mcw.edu.
Insights
Hospital-based violence intervention programs (HVIPs) successfully increased referrals for pediatric patients experiencing interpersonal violence. This quality improvement initiative significantly boosted the referral rate, though enrollment requires further attention.
Area of Science:
- Pediatric emergency medicine
- Public health
- Trauma-informed care
Background:
- Pediatric tertiary care hospitals face high rates of firearm injuries.
- Hospital-based violence intervention programs (HVIPs) are effective in reducing violent injury recidivism.
- Gaps exist in delivering trauma-informed services to families of injured children.
Purpose of the Study:
- To increase the HVIP referral rate by 20% for children experiencing interpersonal violence in the emergency department (ED) within 12 months.
- To identify and address barriers in the HVIP referral process for pediatric patients.
- To improve the delivery of violence intervention services to at-risk youth.
Main Methods:
- A quality improvement study conducted at a pediatric tertiary care hospital.
- Root cause analysis involving stakeholders to identify referral gaps.
- Implementation of electronic medical record (EMR) trigger tools and staff education to enhance HVIP referrals.
Main Results:
- The ED HVIP referral rate increased from 53.6% to 93.5% post-intervention, a 74.4% rise.
- Interventions significantly improved the rate of HVIP-eligible referrals from the ED.
- Sustained high referral rates were achieved after implementing EMR-based triggers.
Conclusions:
- Interventions effectively addressed missed HVIP-eligible referrals, substantially increasing the referral rate.
- Despite increased referrals, enrollment in HVIPs did not significantly improve, highlighting a need for further strategies.
- Enhancing the referral process is a critical step, but additional efforts are required to boost program enrollment and impact.
Background:
Our pediatric tertiary care hospital sees a high rate of firearm injuries. Hospital-based violence intervention programs (HVIPs) reduce violent injury recidivism rates in victims. However, significant gaps exist in the delivery of trauma-informed services to families. Our specific aim was to increase our HVIP referral rate by 20% over a 12-month time frame for children seen for interpersonal violence in the emergency department (ED).
Methods:
Our quality improvement study was done at a pediatric tertiary care hospital and encompassed patients 0 to 18 years of age who presented to our ED for assault-related concerns from December 26, 2021 to June 23, 2024. The primary outcome measure was percentage of HVIP-eligible patients who received a referral from the ED. We conducted a root cause analysis by interviewing stakeholders including HVIP staff, ED providers, nurses, and social workers to understand gaps in the referral process. Key drivers included electronic medical record (EMR) trigger tools for referral placement, accessibility of HVIP staff, and staff knowledge of HVIP eligibility and services. We integrated three main EMR-based interventions on June 15, 2023 that triggered referrals to the HVIP.
Results:
Our ED HVIP referral rate during the pre-intervention period (December 26, 2021 to June 15, 2023) was 53.6%. During our post-intervention phase (June 15, 2023 to June 23, 2024), the referral rate reached and sustained at 93.5%, a 74.4% increase.
Conclusions:
We identified a large percentage of missed HVIP-eligible referrals and developed interventions that significantly increased our referral rate. However, this did not translate into increased enrollment, indicating the need for additional efforts.
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