Citation

Gittelman MA, Denny S, Anzeljc S, FitzGerald M, Arnold MW. J. Trauma Acute Care Surg. 2015; 79(3 Suppl 1): S9-S14.

Affiliation

From the Division of Emergency Medicine (M.A.G., M.F.), Cincinnati Children's Hospital Medical Center, Cincinnati; Division of Emergency Medicine (S.D.), Nationwide Children's Hospital, Columbus; and Ohio Chapter of the American Academy of Pediatrics (S.A., M.W.A.), Worthington, Ohio.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000672

PMID

26131790

Abstract

BACKGROUND: Because of a lack of time and training, many pediatricians often address few, if any, injury topics during well-child visits. The project goal was to increase the injury anticipatory guidance topics covered by pediatricians during well-child visits by offering screening tools and focused talking points through a quality improvement learning collaborative.

METHODS: Screening tools were developed and pretested. Pediatric practices, recruited through the Ohio American Academy of Pediatrics, were taught quality improvement theory and injury prevention strategies at a learning session. Pediatricians worked to implement screening tools and talking points into every well-child visit for children 1 year or younger. Monthly, providers reviewed five random charts for each of the six well-child visits for screening tool use and age-appropriate injury prevention discussion. Providers received maintenance of Certification IV credit.

RESULTS: Sixteen pediatricians (six practices) participated. Screening tool use increased from 0% to 97.2% in just 3 months of the program. For each well-child care visit, injury prevention discussion increased by 89.5% for newborn visit, 88.1% for 2-month, 93.6% for 4-month, 94.0% for 6-month, 88.1% for 9-month, and 90.3% for 12-month-old babies. During the quality improvement program, discussion points for all children 1 year or younger increased for all age-appropriate topics. The greatest percent increase in discussions occurred with water safety (from 10.8% to 95.7%, n = 231), play safety (from 17.9% to 93.5%, n = 154), and supervision safety (from 20.8% to 94.4%, n = 251). More commonly addressed topics also had a significant increase in discussions: sleep safety (from 48% to 93.9%, n = 262), choking (from 44.7% to 95.4%, n = 172), and car safety (from 41.2% to 80.1%, n = 332).

CONCLUSION: Participation in a maintenance of Certification IV quality improvement program within pediatric offices can increase screening and discussion of injury anticipatory guidance. LEVEL OF EVIDENCE: Diagnostic test, level III.

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Language: en