Dataset Information

Simple intervention to improve detection of child abuse in emergency departments.

ABSTRACT:

Problem

Child abuse is easily overlooked in a busy emergency department.

Design

Two stage audit of 1000 children before and after introduction of reminder flowchart.

Background and setting

An emergency department in a suburban teaching hospital seeing about 4000 injured preschool children a year.

Key measures for improvement

Number of records in which intentional injury was adequately documented and considered and the number of children referred for further assessment before and after introduction of reminder flowchart into emergency department notes.

Strategies for change

Nurses were asked to insert a reminder flowchart for assessing intentional injury into the notes of all children aged 0-5 years attending the department with any injury and to record the results of checking the child protection register. EFFECT OF CHANGE: Documentation of all eight indicators that intentional injury had been considered had increased in the second audit. Records of compatibility of history with injury and consistency of history increased from less than 2% to more than 70% (P<0.0001). More children were referred for further assessment in the second audit than the first, although the difference was not significant (6 (0.6%) v 14 (1.4%), P=0.072). The general level of awareness and vigilance increased in the second audit, even for children whose records did not contain the flowchart.

Lessons learnt

Inclusion of a simple reminder flowchart in the notes of injured preschool children attending the emergency department increases awareness, consideration, and documentation of intentional injury. Rates of referral for further assessment also increase.

SUBMITTER: Benger JR

PROVIDER: S-EPMC1122710 | biostudies-literature | 2002 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Simple intervention to improve detection of child abuse in emergency departments.

Benger Jonathan R JR Pearce V V

BMJ (Clinical research ed.) 20020301 7340

<h4>Problem</h4>Child abuse is easily overlooked in a busy emergency department.<h4>Design</h4>Two stage audit of 1000 children before and after introduction of reminder flowchart.<h4>Background and setting</h4>An emergency department in a suburban teaching hospital seeing about 4000 injured preschool children a year.<h4>Key measures for improvement</h4>Number of records in which intentional injury was adequately documented and considered and the number of children referred for further assessmen ...[more]

PMID: 11924662

Similar Datasets

Project description:BackgroundOvercrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments.MethodsA systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group.ResultsThe interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient.ConclusionsIntroducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Project description:IMPORTANCE:Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization. OBJECTIVE:To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients. DESIGN, SETTING, AND PARTICIPANTS:Between October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n?=?431), SAR (n?=?427), or BI-B (n?=?427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers. INTERVENTIONS:Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 "booster" sessions by telephone during the month following the ED visit. MAIN OUTCOMES AND MEASURES:Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up. RESULTS:Follow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (-0.80 to 2.24), P (adjusted)?=?.57; SAR vs BI-B, 0.70 (-0.83 to 2.23), P (adjusted)?=?.57; SAR vs MSO, -0.02 (-1.53 to 1.50), P (adjusted)?=?.98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant. CONCLUSIONS AND RELEVANCE:In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED. TRIAL REGISTRATION:clinicaltrials.gov Identifier:NCT01207791.

Dataset Information

Simple intervention to improve detection of child abuse in emergency departments.

Problem

Design

Background and setting

Key measures for improvement

Strategies for change

Lessons learnt

Publications

Simple intervention to improve detection of child abuse in emergency departments.

Similar Datasets

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