P3.L223: Novel Strategies to Increase Injury Prevention Screening and Counseling in the Pediatric Emergency Department

Purpose/Objectives: The American Academy of Pediatrics (AAP) recommendations include anticipatory guidance and counseling on injury prevention (IP) as both an educational and motivational tool to keep children safe, including around firearm safety. Prior studies have shown that efforts to increase screening and education in pediatric settings result in improved safety behaviors reported by families. Posters have been shown to facilitate education and discussion between patients and providers. Other studies have reported that most families are interested in firearm safety discussions with clinicians, and that physician led anticipatory guidance can increase safe household firearm storage behaviors.
The purpose of this project is to increase IP screening and counseling in the pediatric emergency department (ED) at Dell Children’s Medical Center (DCMC) by creating signage on important IP topics and by increasing awareness and education among providers using quality improvement methodologies.

Design/Methods: We anonymously surveyed pediatric ED providers about current IP counseling practices and perceived barriers. We created a poster detailing the top 6 IP topics in line with AAP Bright Futures (firearm safety, poisoning prevention, helmet use, water safety, motor vehicle safety, and safe sleep) and have placed them in patient rooms and around the ED. Gun trigger locks were secured and made available for staff to distribute to patients. We are currently in the first PDSA cycle and will collect a post survey 60 days after the start to determine if there was impact on current practice. Subsequent Plan-Do-Study-Act (PDSA) cycles will incorporate feedback and survey results to continue the iterative QI process.

Results: Thirty-nine (39) providers answered the survey which was a 68% response rate for our group. This group included fellows, faculty and advanced practice providers. There was variability in frequency with which providers reported counseling on different IP topics. The topics on which providers most frequently reported counseling were car safety and safe sleep, while firearm safety was the least frequently discussed (Fig 1). Time constraints were the most common identified barrier (94.9%), followed by not being related to the chief complaint (79.5%). A majority of providers (71.8%) felt a visual prompt would help with IP counseling in the ED.

Conclusion/Discussion: The pediatric ED cares for injured children and also often serves as a point of contact with the health care system for patients who cannot access primary care. This makes it a prime site to engage in injury prevention screening and discussions with patients and families. We identified barriers and variability among pediatric ED providers in providing IP counseling and seek to improve our IP engagement using QI methodology. We are pending results from our first cycle and plan to continue PDSA cycles based on ongoing data collection.