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Background:
Unintentional injuries are the leading cause of death in children > 1 year of age. These injuries can vary by age, race, gender and location. Literature regarding the location of injuries, urban versus rural, has not been clearly established in the US. The purposes of this study were to determine the rates of severe unintentional injuries in children aged 0-14 years in urban versus rural Ohio counties to see if significant differences exist and to examine urban/rural differences in types of injuries and injury severity.
Methods:
Demographic and injury data on children 0-14 years old who suffered unintentional injuries, from 1/1/2003-12/31/2012 were extracted retrospectively from the Ohio Trauma Acute Care Registry. We calculated injury rates using county of residence and US census data. We assigned each county to an urbanization level based on population density (“A” = most urban; “B” = less urban, “C” = more rural, “D” = most rural). Rates are per 100,000 children <14 years old per year. Frequencies, Chi-square analysis and ANOVA were used to characterize the populations and look for differences between groups.
Results:
45,347 patients were included from the 88 Ohio counties; the overall injury rate was 202.1. The mean age was 6.8 years (SD 4.5); 29,122 (64.2%) were male and 35,166 (75.5%) Caucasian. 611 (1.3%) died. Specific Ohio county of injury was not documented in 4,722 patients leaving 40,625 patients for analysis by urbanization level; overall injury rate for this cohort was 231.9. Injury rates by urbanization level were: A: 120.4, B: 196.8, C: 249.1 and D: 247.4 (p=0.04). Mean Injury Severity Score was highest for those from the most urban areas (A 6.4, B 5.2, C 5.4, D 5.7 (p<0.001). Mean LOS (days) was also highest for those from the most urban areas (A 3.4, B 2.4, C 2.7, D 2.5, p<0.001). Those in the most urban areas were more likely to suffer burns, gunshot wounds, drownings, and suffocations and less likely to suffer animal bites and motor vehicle collisions (p<0.001); they were also more likely to be Hispanic or African American (p<0.001). In addition, 45% (273) of deaths occurred in children living in the most urban areas.
Conclusions:
We found a significant association between unintentional injury rate and urbanization level in young Ohio children. Rural counties experienced more injuries than urban; however, those from the most urban areas had more severe injuries.
Objectives:
Background:
The Impact Program is an adolescent, injury prevention program with both school and hospital-based components aimed at preventing injury and decreasing high-risk behaviors. The objective of this study was to obtain student input on the various aspects of the school-based component of the Impact program, as part of the program evaluation and re-design process.
Methods:
During 2013, a series of 9 secondary schools were selected in various geographic regions of our city and county to get a mix of students varying in primary language, religion and socioeconomic status. A mixed-methods questionnaire was developed and pre-tested on program content, format, relevance, quality and effectiveness. For the quantitative component, an interactive classroom communication “clicker” system was utilized to engage students and allow them to contribute their opinion anonymously. Attitude and opinion questions were ranked on a 7-point Likert scale. Open-ended, qualitative questions were included in the focus groups, with responses recorded and themed.
Results:
There were a total of 167 respondents at the focus groups with a mean age of 16 years. Approximately half (52%) were male and 69% were in grade 11. Ninety-three percent of respondents rated the content of the Impact presentation as comprehensive (median 6 out of 7, with 7 being very comprehensive). The general consensus from respondents (89%) was that the Impact presentation was relevant and addressed issues for teens at their school and their group of friends (median 6 out of 7, with 7 being very relevant). Suggestions of emerging issues or issues to emphasize in the Impact program included texting, consequences of drugs, partying, self-harm and abusive relationships. The most prevalent motor vehicle collision (MVC)-related issue for teens was texting and driving (78% rated as “common”), followed by drugs and driving (54% rated as common) and drinking and driving (29% rated as common) (p<0.001). Texting and driving was perceived significantly more common an issue for adolescents than other types of driving risk factors, with one student commenting, “if you don’t (text and drive) you either don’t have a phone or don’t have a driver’s license.” Twenty-nine percent of respondents rated the format of Impact a 5 on the 7-point Likert scale. When asked how to improve the program, students wanted “more photos and videos” and to hear “the stories…the accounts”.
Conclusions:
Injury prevention programs must continually be evaluated to ensure they are relevant, addressing issues important for youth in your region, and presented in a format that resonates with the audience. The results of our student focus groups identified MVCs and texting as important issues, as well as a desire for the teens to hear the personal stories along with a visual element. This provided our team with the information needed to develop the next logical direction for our program; the production of a distracted driving video (“Distracted Driving: Josh’s Story” http://youtu.be/BFPke9gBybc) to be incorporated into the school presentations.
Background:
Upon admission all patients less than 4’ 9” seen in the Emergency Room, Clinic offices, Child Protection Center, Day Surgery and Inpatient units are screened for car seat needs. Trained car seat educators complete car seat consults with caregivers to distribute seats, teach them to fit their child into the seat and complete necessary documentation.
Methods:
The car seat educator model was created as a step down model of the Child Passenger Safety Technician (CPST) to distribute hospital issued seats. In 2004 there were 30 trained car seat educators. Today we have over 180 Car Partners, RNs and Respiratory Therapists that are trained as car seat educators at multiple CHW sites to distribute regular car seats, adjust infant seat harness straps to fit patients for car seat trials, loan hip spica seats and vests and distribute car beds. Initial educator trainings are offered monthly and consist of an online course and a 60-90 minute hands-on training. Ongoing trainings for staff, readily available car seat consult resources, the electronic health record, staff newsletters, a system wide car seat committee and staff members across multiple departments (both hospital and community based) help us manage daily program activities. A hospital budget for car seats, Foundation support, a grant through the Wisconsin Department of Transportation and recipient donations cover the cost of seats.
Results:
In 2013 approximately 400 infant, convertible, forward-facing harness seats, booster seats and car beds were distributed and about 100 seats for patients with hip spica casts and braces were loaned. Units and departments are self sufficient in meeting the car seat needs of their patients. The car seat consult process allows us to avoid delayed discharges. The program is more sustainable with many trained staff members. Staffing CPST to meet the car seat needs in an organization that is open 24/7 can be both tricky and costly. The car seat educator model is a more affordable model that allows us to train many staff members to meet the car seat needs of our families.
Conclusions:
Motor vehicle crashes are the number one cause of death for children. Our multi-faceted car seat program allows us to better identify families in need of car seats and provide car seat education.
Background:
Injuries cause more deaths to the pediatric population than all diseases combined. This program teaches pediatricians injury prevention principles, how to use tools in their office setting, and how to engage families to make changes in their behavior so their children are safer and injuries can be reduced. While performing this work, pediatricians can obtain maintenance of certification (MOC) credit.
Methods:
Both MOC 2 and 4 program development over the past 3 years will be reviewed. The Ohio AAP became an American Board of Pediatric's (ABP) portfolio sponsor. As injuries cause significant morbidity, the Ohio Chapter worked to develop a screening tool to assess current family behaviors for children in the household < 1 year of age. Pediatric practices were recruited nationally to implement the tool into every WCC visit for appropriate aged children and providers were given talking points to discuss inappropriately answered topics. Surveys are provided at multiple visits to assess behavior changes by families over time. All participating providers submit their data to a centralized database and behavior changes are assessed for all families. Frequencies for screening tool use and appropriate injury prevention discussions are calculated. Also, an MOC 2 program was developed by study staff and approved by the ABP. Discussions of how articles were chosen and questions developed will be discussed. Within only a 10-month period physicians earn 25 points of MOC 4 credit and 20 points of MOC 2 credit; enabling them to complete half of their ABP requirements.
Results:
Over 23 practices and 100 providers have participated over the past 3 years. Implementation of the screening tool is easily incorporated into an everyday pediatric practice in just 1-2 months. Pediatrician injury prevention discussion increased by 70% for all recommended injury prevention topics for children < 1 year of age. Family behavior change by age of child and mechanism of injury will be reviewed. Finally, the ease of obtaining MOC 2 credit by participating pediatricians while participating in the quality improvement program will be discussed.
Conclusions:
Participation in a MOC Part 2 and 4 QI program within pediatric offices can increase screening and discussion of injury prevention practices. As a result of these programs, pediatricians learned injury prevention principles, increased discussions with families, and instigated more reported behavior changes by families at later visits.
Objectives:
1) Describe how MOC 2 and 4 programs are developed 2) Demonstrate how to work with office staff to incorporate injury QI in the office to obtain MOC 4 credit 3) Discuss how our team has evaluated the success and spread the program nationally
Background:
Ohio currently has the 4th highest infant mortality rate in the United States and the 2nd highest African-American infant mortality rate. Sleep-related deaths account for the highest percentage of these deaths behind prematurity. It has become imperative that healthcare providers educate parents/caregivers about the importance of following safe sleep practices at home, as well as mimicking them in the hospital setting. Unfortunately, studies have shown that over half of children’s hospitals are not adhering to published infant Safe Sleep guidelines. The Ohio AAP chapter has recently initiated the EASE (Education and Sleep Environment) Project, a quality improvement project in six children’s hospitals in Ohio created to improve the sleep environments of hospitalized infants. The EASE Project’s objectives are two-fold and seek to increase the quantities of safe sleep behaviors being practiced in Ohio’s children’s hospitals, as well as to provide safe sleep education to parents/caregivers of hospitalized infants at discharge.
Methods:
Pediatric hospitalists from each of the six children’s hospitals were invited to participate in this project in January 2014. The hospitalists were asked to form “safe sleep teams”, comprised of physicians and nursing staff, within their institutions. The hospitalists and their committees are responsible for conducting at least ten weekly audits on the sleep environments of their hospitalized infants and submitting them to an online project database for data analysis. Three PDSA cycles of the safe sleep teams’ choosing are also required over the 12-month study period and can include policy creation/amendments, health care provider education measures, parent/caregiver education modalities, and/or environmental management strategies. Monthly Action Period Calls are being conducted to address any concerns, to assess progress, and to provide additional education and resources for project participants.
Results:
Since data collection began in February 2014, we have shown an improvement in hospitalized infants being placed in a safe sleep environment. A large majority (85%) are now being placed on their backs in their cribs when sleeping. We continue to face problems with the crib environments themselves, with loose blankets and toys still present in 38% of cribs, though this has improved from 50%. We are successfully educating the families of hospitalized infants about safe sleep practices 76% of the time, improved from 49%.
Conclusions:
Preliminary results indicate that a hospitalist-led quality improvement project has improved safe sleep practices in six children’s hospitals in Ohio in the first months of its timeline. We expect the quantities of these practices to increase over the next several months as further PDSA cycles are completed. We anticipate that demonstrating these behaviors in the hospital setting may lead to more appropriate safe sleep practices at home, potentially resulting in fewer sleep-related deaths in Ohio.
Background:
The American Academy of Pediatrics recommends car seats and booster seats to be used for children < 8-12 years old and less than 57 inches when in a motor vehicle. In the state of Massachusetts the laws require children < 8 years old and less than 57 inches to be restrained in a car seat or booster seat. Hospital programs can be important sources of child passenger safety (CPS) information, and they can also provide child safety seats to those in need. In 2010 we established a CPS program on the inpatient units, and in 2011 we established one in the emergency department (ED). In the inpatient unit, CPS screening is a voluntary computerized field completed during the initial nursing assessment and recorded in the medical record. In the ED it is a mandatory computerized field in the initial nursing assessment. Child safety seats are distributed if a need is identified. The objective of this program evaluation is to analyze compliance with the CPS nursing screening in the inpatient and ED setting and to describe patterns of car seat distribution over the time periods of the programs.
Methods:
This is a retrospective record review of children < 8 years old screened for CPS needs at a tertiary care children’s hospital. Records for children in the inpatient units and those discharged from the ED were reviewed from August 1, 2011 through December 31, 2014. Frequencies of car seat screenings and child safety seat distribution by type of seat were calculated. We conducted Poisson regression to analyze CPS screening over time.
Results:
From 2011-2014, 27% (7,179/26,967) of children< 8 years old admitted to the inpatient unit had CPS nursing screening completed. Of those screened, 3.7% (265/7,179) needed a car seat for discharge home. Of children discharged from the ED, 77% (89,182/115,601) had CPS nursing screening completed, with 93% (31,112/33,537) screened in 2014. Among those screened, 2.0% (1,746/89,182) did not have a car seat for discharge home. Through the two CPS programs 116 seats were distributed in 2013 (4 infant, 25 convertible, 16 combination, 18 boosters, 29 Hippos, 7 car beds, and 17 vests) and 155 in 2014 (5 infant, 49 convertible, 12 combination, 26 boosters, 33 Hippos, 10 beds, 20 vests). Poisson regression revealed increased CPS screening in the ED (p < 0.0001), but not in the inpatient units over time.
Conclusions:
Inpatient and ED CPS programs with computerized nursing screening may be useful to assess patients < 8 years old for CPS needs. Increased compliance was observed in the ED with the mandatory computerized nursing assessment field. Various types of child safety seats can be provided as the need is determined, including specialty car seats for children.
Objectives:
1) Understand the importance of program evaluation for hospital based child passenger safety programs. 2) Describe the types of child safety seats needed for patients served by hospital based child passenger safety programs. 3) Illustrate differences in compliance by types of computerized screening for child passenger safety.
