• Gunjan Tiyyagura, Beth Emerson, Julie R Gaither, Kirsten Bechtel, John M Leventhal, Heather Becker, Karen Della Guistina, Thomas Balga, Bonnie Mackenzie, May Shum, Eugene D Shapiro, Marc A Auerbach, Caitlin McVaney, Patricia Morrell, and Andrea G Asnes.
• From the, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
• Acad Emerg Med. 2021 Jan 1; 28 (1): 70-81.

ObjectivesEmergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children < 12 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months.MethodsWe interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan-do-study-act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children < 1 year old with high-risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS).ResultsEvidence of special cause was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8-month period, the CPT was consulted for a mean of 47.5% of children with high-risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high-risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%.ConclusionTargeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high-risk injuries. Such interventions may improve recognition of physical abuse.© 2020 by the Society for Academic Emergency Medicine.

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