985 Quality improvement interventions increase adherence to guideline for evaluation and treatment of sexual abuse victims in a paediatric emergency department. (21st November 2017)

• Record Type: Journal Article
• Authors: Hoehn, Erin; Overmann, Kevin; Fananapazir, Nafeh; Bennett, Berkeley; Duma, Elena; Kurowski, Eileen Murtagh
• Is Part Of: BMJ open quality. Volume 6:Supplement 1(2017)
• Page Start: A20
• Page End: A21
• Publication Date: 2017-11-21
• Subjects: Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2017-IHI.19
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Background: Appropriate medical care of sexual abuse victims who present to the paediatric emergency department (PED) is vital to facilitate forensic evidence collection and prevent pregnancy and sexually transmitted infections. Despite recommendations from the American Academy of Paediatrics and Centres for Disease Control, adherence to guidelines remains low. Objectives: We aimed to increase the proportion of patient encounters at a PED for reported sexual abuse that receive guideline-adherent care from 57% to 90% within 12 months. Methods: Our team of PED and child abuse paediatricians constructed a key driver diagram to outline our theory for improvement (Figure 1). Multiple plan-do-study-act cycles were conducted to test interventions aimed at key drivers, including construction of a best practice algorithm, targeted clinician education, and integration of an electronic order set. Our primary outcome was the proportion of patient encounters in which care adhered to guideline recommendations. Data were abstracted from the records of all patient encounters evaluated in the PED for reported sexual abuse. Results: We analysed 567 patient encounters for reported sexual abuse over 24 months. A statistical process control chart depicting the proportion of encounters with guideline-adherent care (Figure 2) illustrates special cause variation and a shift in the centerline from 57% to 87% which has been sustained for 7 months. We categorised reasons for non-adherence on a Pareto chart (Figure 3). Conclusions: Using improvement methodology, we successfully increased guideline-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 guideline.