Quality Improvement Initiative Improves Screening for Child Physical Abuse

Child physical abuse is frequently missed, often resulting in recurrent or escalating injury. Testing for occult injuries can improve abuse recognition, but testing decisions vary and are often based on race or socioeconomic status (NEJM JW Emerg Med 2017 Dec and Pediatrics 2017; 140:e20171188). These authors at a single pediatric emergency department developed an evidence-based guideline for testing and implemented a quality improvement toolkit for evaluating suspected abuse in children <3 years old.

The toolkit included the testing guideline integrated into the electronic health record, education for providers, an age-based order set, and a communication strategy for discussing the need for testing with families. To assess the impact of th…