P0221 - Care Coordination of Child Abuse Medical Evaluations: A Quality Improvement Project

Background: Effective communication between primary care and consultation healthcare providers is essential to providing quality care. It is well known that seamless transitions in care can improve patient outcomes, patient satisfaction, and also decrease care costs1. In contrast to traditional specialist evaluations, child abuse consultations are complex in that they are sensitive in nature while having both clinical and forensic/legal significance. Specifically at The University of Texas Southwestern and Children’s Health, these evaluations are performed by providers in the REACH (Referral and Evaluation of at Risk Children) clinic. At this time, no standardized post-consultation primary care provider (PCP) care coordination exists. However, it is the primary care physicians who ultimately serve as the long-term medical home for these patients. To balance the desire to protect patient confidentiality and encourage effective transitions in care, we created an abbreviated post-consultation summary template in the electronic medical record (EMR) which can be automatically sent to the PCP upon completion of the clinic visit.

Aim: This project aims to increase the percentage of new patient REACH clinic encounters with documented PCP care coordination from 0% to 60% in patients whose parents provide consent and PCP information by July 1st, 2020.

Methodology: Quality improvement methodology, specifically Plan, Do, Study, Act cycles were used to assist in clinic workflow change and implementation of this project. Data was collected via retrospective chart review from 1/1/2020 to 3/31/2020 and included new pediatric patients (age newborn to 18 years old) seen at the REACH clinic. Baseline PCP care coordination documentation prior to the intervention was determined to be 0%. Next, a multi-disciplinary group consisting of child abuse pediatricians, a psychologist, and a forensic nurse practitioner attended focus group meetings to create and troubleshoot the abbreviated post-consultation summary template tool (Figure 1). The intervention was performed on 3/25/2020 and included educating providers and clinic staff regarding use of the standardized template in the EMR. A second retrospective chart review will be performed from 4/1/2020 to 6/30/2020 to determine improvement post-intervention. A final chart review will be performed from 7/1/2020 to 9/30/2020 to determine sustainability and data will be displayed in a run chart.

Discussion/

Conclusion: We are hopeful that through standardization, simplification, and education this intervention will aid in improving post-consultation coordination of care of suspected child abuse and neglect patients. We believe this project may be informative to other child abuse specialty medical clinics or child advocacy centers. After completion of this project, our next steps will be to follow up with community PCPs to solicit feedback and suggestions.

References: 1) Shamji, H., et al. (2014). "Improving the quality of care and communication during patient transitions: best practices for urgent care centers." Jt Comm J Qual Patient Saf 40(7): 319-324.