Improving clinician knowledge, comfort, and adherence to standard of care for suspected child abuse.

INTRODUCTION

This quality improvement project aimed to improve clinician knowledge, comfort, and adherence to standard of care for suspected cases of child abuse and neglect.

METHODS

A multi-pronged child abuse identification QI program was implemented within a large integrated healthcare system in Southern California to educate physicians on the detection and appropriate work-up for suspected child abuse and neglect. This included educational modules, webinars, and updated clinical support tools. A survey was given to clinicians who completed the educational modules regarding their comfort and knowledge with child abuse protocols. Use of skeletal surveys, the standard of care for suspicious injuries, was examined for patients < 12 months old presenting with skeletal fractures, sentinel injuries, and head trauma.

RESULTS

For clinicians who completed the educational modules, 97% reported increased confidence in identifying child abuse cases, while 95% reported increased confidence in managing such cases (p<.01). For children < 6 months old with skeletal fractures there was a significant increase in skeletal surveys from 4% to 17% and for children 6-12mos an increase from 6 to 14% (ps<0.01). For children < 6 months old with sentinel injuries, the rate in skeletal surveys increased from 2% to 8% and for those with sentinel injuries or fracture the rate of skeletal surveys increased from 3% to 10% (ps<0.01). For children < = 12months old with head trauma, the rate of skeletal surveys increased from 8%-23%(ps<0.01).

CONCLUSION

Overall, the findings suggest the QI program contributed to substantial improvement in adherence to standard of care for suspected child abuse.