Improving Emergency Department Care for Pediatric Victims of Sexual Abuse

被引:8
作者
Hoehn, Erin F. [1 ,3 ]
Overmann, Kevin M. [1 ,3 ]
Fananapazir, Nafeh [1 ,3 ]
Simonton, Kirsten [2 ]
Makoroff, Kathi L. [2 ]
Bennett, Berkeley L. [4 ,5 ]
Duma, Elena M. [1 ,3 ]
Kurowski, Eileen Murtagh [1 ,3 ]
机构
[1] Cincinnati Childrens Hosp Med Ctr, Div Emergency Med, 3333 Burnet Ave,ML 2008, Cincinnati, OH 45229 USA
[2] Cincinnati Childrens Hosp Med Ctr, Mayerson Ctr Safe & Hlth Children, Cincinnati, OH 45229 USA
[3] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati, OH USA
[4] Nationwide Childrens Hosp, Div Emergency Med, Columbus, OH USA
[5] Ohio State Univ, Coll Med, Dept Pediat, Columbus, OH 43210 USA
关键词
ASSAULT;
D O I
10.1542/peds.2018-1811
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BACKGROUND AND OBJECTIVE: Evidence-based medical care of sexual abuse victims who present to the pediatric emergency department (PED) is necessary to facilitate forensic evidence collection and prevent pregnancy and sexually transmitted infections. Adherence to testing and treatment guidelines remains low in PEDs, despite recommendations from the American Academy of Pediatrics and Centers for Disease Control and Prevention. We aimed to increase the proportion of patient encounters at a PED for reported sexual abuse that receive algorithm-adherent care from 57% to 90% within 12 months. METHODS: Our team of PED and child abuse pediatricians outlined our theory for improvement, and multiple plan-do-study-act cycles were conducted to test interventions that were aimed at key drivers. Interventions included the construction of a best practice algorithm derived from published guidelines, targeted clinician education, and integration of an electronic order set. Our primary outcome was the proportion of patient encounters in which care adhered to algorithm recommendations. Data were abstracted from the records of all patient encounters evaluated in the PED for reported sexual abuse. RESULTS: We analyzed 657 visits between July 2015 and January 2018. The proportion of patient encounters with algorithm-adherent care improved from 57% to 87% during the study period. This improvement has been sustained for 13 months. Failure to test for hepatitis and syphilis constituted the majority of nonadherent care. CONCLUSIONS: Using improvement methodology, we successfully increased algorithm-adherent evaluation and management of patients presenting for sexual abuse. Targeted education and an electronic order set were associated with improved adherence to a novel care algorithm.
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页数:6
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