Resident Albert Einstein College of Medicine/Jacobi Medical Center New Rochelle, New York, United States
Background: Screening for non-accidental trauma (NAT) among young children is a requirement of pediatric emergency departments (PED) and requires visualization of the child’s entire body. There is less visibility of accidental and non-accidental trauma when patients are in casual attire instead of gowns. Studies have shown significant increase in NAT detection when using the Ten4Faces screen which incorporates a full skin exam; but no studies thus far have directly evaluated the effect of increased gowning on NAT detection. Objective: Our objective is to improve detection rate of significant physical exam findings in patients < 4yo presenting to Jacobi PED by increasing use of hospital gowns to 40% over a 6 month period. Design/Methods: This QI project was developed from a prior QI project at our institution which aimed to improve documentation and identification of NAT in the PED by using Ten4Faces. This current initiative includes a collaborative of nursing, patient care aides, administration, linen supply, PED attendings, fellows, residents and nurse practitioners that met to develop the goals, processes and outcomes. The process changes include assigning nursing and aide responsibility for gowning immediately from triage or once placed in a room. Education of staff is done via staff meetings, daily PED huddle announcements, and monthly email reminders. Changes were made to gown supply, location, and monitoring of gown availability. Daily audits review all roomed children in the PED < 4yo and documented why patients were not gowned. The main outcome measure is the percentage of patients < 4yo gowned appropriately in our PED divided by the number of patients audited. A routine survey is completed by staff to determine project effectiveness, perceived parental acceptance, and suggestions for improvement. Our balancing measure is % NAT detection rate. Audit data, pre and post project implementation, will be analyzed for outcome and balancing measures as noted above.
