Evaluation of a Hospital-driven Drowning Prevention Program in Pediatric Primary Care Settings

Tiffaney Isaacson, BS
Yezan “iPod” Hassan, BA, BS, BSHS
Bianca Cardiel, BSW
Angelica Baker, BA
Jodi Brigola, BA, MA
Catherine Tretiakova, DNP, RN, CPNP-PC
Jessica Wani, JD
Roy Jedeikin, MD, MBBCH, FAAP, FACC, MBA
Diana Bowman, PhD

Drowning in the United States (U.S.) is endemic to the pediatric population, representing the leading cause of unintentional injury death for children aged one to four years and generating medical costs of $17.5 million in 2020. In Arizona, the drowning rate for children in this age group is nearly double the national rate. Pediatric primary care providers (PCPs) are in a central position to lead drowning prevention efforts because they have regular access to caregivers of children in the highest risk age group and are trained to deliver injury prevention information. However, pediatricians face a number of barriers to delivering anticipatory guidance, including competing topics and limited time. The Pediatric Drowning Prevention (PDP) pilot program is a quality improvement study which seeks to increase frequency and quality of drowning prevention anticipatory guidance delivered to caregivers of children aged one to four years during well child visits.

Arizona pediatric PCPs who conduct well child visits for children aged one to four years in the metropolitan Phoenix area were eligible to participate. Recruiting took place in partnership within a clinically integrated network of pediatric PCPs. Participants received curriculum and drowning prevention resources during two brief luncheons, delivered two to seven months apart. Additional quality improvement resources were provided when the project achieved Maintenance of Certification approval, including PDSA guidelines. MOC details and effects will be examined in a subsequent analysis. Surveys at both luncheons measured provider frequency and quality of drowning prevention education, including the effects of caregiver stress, use of life jackets, and limitations of swim lessons. Surveys also examined provider propensity to discuss the connection between developmental milestones and drowning risk, and perception of overall program efficacy. Responses were analyzed using appropriate statistical tests.

At eight practices, 33 PCPs were recruited between March 2020 and November 2021. A total of 750 handouts, 132 posters, and 525 water safety sunscreen packets were distributed. Survey results showed a significant increase between pre- and post-surveys in willingness to share drowning prevention education and discuss the connection between developmental milestones and drowning risk (P<0.001).

Furthermore, PCP messaging became more specific and frequent. More participants discussed designating a supervising adult during swim time, several months after education. Additionally, participants advised caregivers against swimming when they are stressed and encouraged use of a U.S. Coast Guard approved life jacket.

Participants unanimously reported that the PDP program increased caregiver knowledge on drownings, risks, and safety strategies, and recommended this program to other primary care offices.

Pilot results are promising. The program positively influenced frequency and messaging of Drowning Prevention anticipatory guidance delivered by pediatric PCPs. As a scalable, replicable program with participant endorsement, the program should expand and be replicated.

1. Explore why new solutions are needed to address drowning prevention messaging during well child visits in children ages 1 – 4 years.
2. Consider new partnerships for injury prevention professionals, to reduce risk in any community.
3. Examine innovative programming, to ensure resiliency during health care disruptions.