P0103 - Pediatric Emergency Department Referrals to a Hospital-Based Violence Intervention Program

Background: Youth violence is a major public health concern in the United States. Hospital-Based Violence Intervention Programs (HVIPs) are integral in connecting youth sustaining interpersonal violence-related injuries to medical, mental health, and social services. At our pediatric emergency department, our baseline referral rate to the established HVIP was 29%.

Objective: We aim to increase referrals to HVIPs services from 29% to 70% within 24mo for patients age 7-18 years who present to our emergency department with a violent injury.
Design/

Methods: We performed process mapping of the referral process that included ED triage, primary nursing intake, provider care, on-line paging systems, and social work interventions. We interviewed key stakeholders including nurses, social workers, and providers to identify specific interventions. We used the model for improvement and PDSA cycles to inform our project. Our primary outcome measure was the number of patients referred to our HVIP and all measures were analyzed using statistical process control charts. Our key interventions were:
1. Educating providers on eligibility requirements
2. Encouraging nurses to enter consults at the time of admission in triage;
3. Publishing information about program referrals in the weekly nursing newsletter
4. Updating social workers on eligibility requirements for the HVIP.
We included all patients between the ages of 7 and 18 who had diagnoses consistent with injuries related to assault, stabbing, or gunshot wounds in a Level 1 pediatric emergency department/trauma center.

Results: From 2018 to 2019, there were 145 referrals to the HVIP, out of 390 eligible patients. The referral rate improved from 29.6% pre-intervention to 39% post-interventions but was not sustained as we experienced significant social worker turn over shortly after achieving this improvement (Figure 1). Additionally, since August 2019, more referrals came from nursing staff. We are working to incorporate the referral process via best practice alerts in the electronic health record to improve sustainability.
Conclusion(s): We noted a temporary improvement in the referral process following our interventions, however, in order to develop a more sustainable process, we recognize the need for a more reliable way to prompt and place referrals. Next steps include best practice alerts to prompt HVIP referral in the electronic health record, follow-up reminders to staff, and gratitude messages to staff placing referrals to the HVIP.