Khan Narmeen I, Chinta Sri S, Cheaton Brooke M, Nimmer Mark, Levas Michael N
Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin Children's Corporate Center, Suite C550 999 N. 92nd St, P.O. Box 1997, Milwaukee, WI, 53201-1997, USA.
Inj Epidemiol. 2025 May 2;12(1):24. doi: 10.1186/s40621-025-00578-w.
Our pediatric tertiary care hospital sees a high rate of firearm injuries. Hospital-based violence intervention programs (HVIPs) reduce violent injury recidivism rates in victims. However, significant gaps exist in the delivery of trauma-informed services to families. Our specific aim was to increase our HVIP referral rate by 20% over a 12-month time frame for children seen for interpersonal violence in the emergency department (ED).
Our quality improvement study was done at a pediatric tertiary care hospital and encompassed patients 0 to 18 years of age who presented to our ED for assault-related concerns from December 26, 2021 to June 23, 2024. The primary outcome measure was percentage of HVIP-eligible patients who received a referral from the ED. We conducted a root cause analysis by interviewing stakeholders including HVIP staff, ED providers, nurses, and social workers to understand gaps in the referral process. Key drivers included electronic medical record (EMR) trigger tools for referral placement, accessibility of HVIP staff, and staff knowledge of HVIP eligibility and services. We integrated three main EMR-based interventions on June 15, 2023 that triggered referrals to the HVIP.
Our ED HVIP referral rate during the pre-intervention period (December 26, 2021 to June 15, 2023) was 53.6%. During our post-intervention phase (June 15, 2023 to June 23, 2024), the referral rate reached and sustained at 93.5%, a 74.4% increase.
We identified a large percentage of missed HVIP-eligible referrals and developed interventions that significantly increased our referral rate. However, this did not translate into increased enrollment, indicating the need for additional efforts.
我们的儿科三级护理医院接诊的枪支伤害发生率很高。基于医院的暴力干预项目（HVIPs）可降低受害者暴力伤害再发率。然而，在为家庭提供创伤知情服务方面存在显著差距。我们的具体目标是在12个月的时间内，将急诊科（ED）因人际暴力就诊的儿童的HVIP转诊率提高20%。
我们在一家儿科三级护理医院开展了质量改进研究，纳入了2021年12月26日至2024年6月23日因与袭击相关问题到我们急诊科就诊的0至18岁患者。主要结局指标是符合HVIP条件并从急诊科获得转诊的患者百分比。我们通过采访包括HVIP工作人员、急诊科医护人员、护士和社会工作者在内的利益相关者进行根本原因分析，以了解转诊过程中的差距。关键驱动因素包括用于转诊安排的电子病历（EMR）触发工具、HVIP工作人员的可及性以及工作人员对HVIP资格和服务的了解。2023年6月15日，我们整合了三项基于EMR的主要干预措施，触发了向HVIP的转诊。
在干预前期（2021年12月26日至2023年6月15日），我们急诊科的HVIP转诊率为53.6%。在干预后期（2023年6月15日至2024年6月23日），转诊率达到并维持在93.5%，增长了74.4%。
我们发现有很大比例符合HVIP条件的转诊被遗漏，并制定了显著提高转诊率的干预措施。然而，这并未转化为登记人数的增加，表明需要进一步努力。
