Cargando…

Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma

INTRODUCTION: The skeletal survey (SS) is used to evaluate and diagnose bone abnormalities, including fractures caused by child abuse. The American Academy of Pediatrics recommends initial SS for all children younger than 24 months old who are suspected victims of abuse and a follow-up skeletal surv...

Descripción completa

Detalles Bibliográficos
Autores principales: Ashraf, Iram J., Faivus Ackley, Danielle, Razawich, Kristin, Botash, Ann, Schafer, Melissa, Pekarsky, Alicia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197371/
https://www.ncbi.nlm.nih.gov/pubmed/35720876
http://dx.doi.org/10.1097/pq9.0000000000000567
_version_ 1784727391021563904
author Ashraf, Iram J.
Faivus Ackley, Danielle
Razawich, Kristin
Botash, Ann
Schafer, Melissa
Pekarsky, Alicia
author_facet Ashraf, Iram J.
Faivus Ackley, Danielle
Razawich, Kristin
Botash, Ann
Schafer, Melissa
Pekarsky, Alicia
author_sort Ashraf, Iram J.
collection PubMed
description INTRODUCTION: The skeletal survey (SS) is used to evaluate and diagnose bone abnormalities, including fractures caused by child abuse. The American Academy of Pediatrics recommends initial SS for all children younger than 24 months old who are suspected victims of abuse and a follow-up skeletal survey (FUSS) 2 weeks later. The latter can further characterize abnormal or equivocal findings, detect ongoing trauma, or fractures too acute for visualization upon initial assessment. METHODS: Preintervention review at our hospital for FUSS completion of children younger than 36 months old yielded a low 40% average monthly completion rate. We reviewed charts of children who underwent SS during the study period for FUSS completion. There were several barriers to FUSS completion, including lack of provider knowledge regarding FUSS importance, lack of an order for FUSS before hospital discharge, absent chart documentation regarding FUSS decision, loss to follow-up, and parental refusal. Interventions targeting the barriers included provider education, protocolizing FUSS scheduling, standardizing documentation, and community pediatrician outreach. The goal was to increase the average monthly FUSS completion rate from 40% to 90% over 1 year. RESULTS: After interventions implementation, the average monthly FUSS completion rate rapidly increased from 40% to 80%. There was sustained improvement over the subsequent 12 months. CONCLUSIONS: Interventions were implemented sequentially, targeting barriers at various levels of workflow. Provider education was key and helped increase the reliability of intervention implementation. The most effective intervention was protocol change. This approach led to significant improvement in FUSS completion and sustained improvement.
format Online
Article
Text
id pubmed-9197371
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-91973712022-06-16 Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma Ashraf, Iram J. Faivus Ackley, Danielle Razawich, Kristin Botash, Ann Schafer, Melissa Pekarsky, Alicia Pediatr Qual Saf Individual QI projects from single institutions INTRODUCTION: The skeletal survey (SS) is used to evaluate and diagnose bone abnormalities, including fractures caused by child abuse. The American Academy of Pediatrics recommends initial SS for all children younger than 24 months old who are suspected victims of abuse and a follow-up skeletal survey (FUSS) 2 weeks later. The latter can further characterize abnormal or equivocal findings, detect ongoing trauma, or fractures too acute for visualization upon initial assessment. METHODS: Preintervention review at our hospital for FUSS completion of children younger than 36 months old yielded a low 40% average monthly completion rate. We reviewed charts of children who underwent SS during the study period for FUSS completion. There were several barriers to FUSS completion, including lack of provider knowledge regarding FUSS importance, lack of an order for FUSS before hospital discharge, absent chart documentation regarding FUSS decision, loss to follow-up, and parental refusal. Interventions targeting the barriers included provider education, protocolizing FUSS scheduling, standardizing documentation, and community pediatrician outreach. The goal was to increase the average monthly FUSS completion rate from 40% to 90% over 1 year. RESULTS: After interventions implementation, the average monthly FUSS completion rate rapidly increased from 40% to 80%. There was sustained improvement over the subsequent 12 months. CONCLUSIONS: Interventions were implemented sequentially, targeting barriers at various levels of workflow. Provider education was key and helped increase the reliability of intervention implementation. The most effective intervention was protocol change. This approach led to significant improvement in FUSS completion and sustained improvement. Lippincott Williams & Wilkins 2022-06-14 /pmc/articles/PMC9197371/ /pubmed/35720876 http://dx.doi.org/10.1097/pq9.0000000000000567 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Individual QI projects from single institutions
Ashraf, Iram J.
Faivus Ackley, Danielle
Razawich, Kristin
Botash, Ann
Schafer, Melissa
Pekarsky, Alicia
Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma
title Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma
title_full Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma
title_fullStr Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma
title_full_unstemmed Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma
title_short Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma
title_sort improving follow-up skeletal survey completion in children with suspected nonaccidental trauma
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197371/
https://www.ncbi.nlm.nih.gov/pubmed/35720876
http://dx.doi.org/10.1097/pq9.0000000000000567
work_keys_str_mv AT ashrafiramj improvingfollowupskeletalsurveycompletioninchildrenwithsuspectednonaccidentaltrauma
AT faivusackleydanielle improvingfollowupskeletalsurveycompletioninchildrenwithsuspectednonaccidentaltrauma
AT razawichkristin improvingfollowupskeletalsurveycompletioninchildrenwithsuspectednonaccidentaltrauma
AT botashann improvingfollowupskeletalsurveycompletioninchildrenwithsuspectednonaccidentaltrauma
AT schafermelissa improvingfollowupskeletalsurveycompletioninchildrenwithsuspectednonaccidentaltrauma
AT pekarskyalicia improvingfollowupskeletalsurveycompletioninchildrenwithsuspectednonaccidentaltrauma