Background: One in three women and one in four men will experience intimate partner violence (IPV), and women between the ages of 16 and 24 experience the highest rate of IPV. Children who are exposed to IPV are at increased risk for child maltreatment and exposure is a toxic stress that may result in poor physical and brain health outcomes. Several federal agencies and professional societies recommend screening for IPV and other forms of violence. Although the pediatric ED (PED) often serves a high-risk vulnerable patient population, in our PED, domestic safety screening was rarely completed. Objective: To improve screening for domestic safety concerns and IPV in a PED. Methods: 1) ED nurse focus groups; and 2) Interventions to improve IPV screening were developed based on focus group results. Quality measures were tracked pre- and post-implementation, including proportion of patients with domestic safety screening completed. Results: 4 focus groups were conducted and the following themes emerged: 1) Nurses believe IPV screening should be conducted in the ED and that it should be mandatory; 2) The screening tool in the electronic health record (EHR) was not conducive to workflow, was ineffective as a way to alert social work (SW), and was therefore often ignored; 3) Nurses emphasized the need for standardized screening questions and SW resources/responses to address positive screens; and 4) Nurses want more formalized training in screening. As a result, the EHR questions were standardized with scripted language and moved to facilitate workflow. The screening fields became highlighted in yellow and put in a prominent place on the assessment page. A positive screen resulted in an automated SW consult. Staff training was provided. Pre-implementation screening rates in our PED were 13% from July to October 2016. Post-implementation screening rates were 92% from October 2016 to February 2017. SW responds to the majority of positive screens as a result of the automated SW consult order. Physician staff provides resources when SW is unavailable. Conclusions: ED nurses identified a need for improved domestic safety screening and believe in mandatory, universal screening. Standardized EHR domestic safety screening questions, a resulting automated SW consult order, and staff training improved domestic safety screening and SW response rates in a PED. Additional training and QI measures are ongoing.
Domestic Safety Screening in a PED: QI Measures for Improved Screening
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Lenore Jarvis, Kristen Breslin, Allison Jackson, Brooke Goodwin, Jeanne Pettinichi, Sarah Taylor, Jaclyn Tapia, Lori Donovan, Monika K. Goyal, Gia M. Badolato, James M. Chamberlain, Bobbe Thomas, Philip Sang, Kathy Brown; Domestic Safety Screening in a PED: QI Measures for Improved Screening. Pediatrics May 2018; 142 (1_MeetingAbstract): 112. 10.1542/peds.142.1MA2.112
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