Presenter Profile
Elizabeth Hendrickson, MD
University of Alabama at Birmingham/Children's of Alabama
epoulos@uabmc.edu
Elizabeth Hendrickson, MD, is a first year pediatric emergency medicine fellow at the University of Alabama at Birmingham/Children's of Alabama. She received her Bachelors of Science in Science and Religion from Samford University before obtaining her medical degree at the University of Alabama at Birmingham Heersink School of Medicine. She completed her pediatrics residency at Washington University in St. Louis/Saint Louis Children's Hospital where she developed a passion for injury prevention and advocacy. Her other research interests include using qualitative methods to investigate the physician-patient relationship in critical and emergency care.
Presentations
A Quality Improvement (QI) Initiative: An Emergency Department (ED) Based Safe Sleep Screening to Improve Access to Safe Sleep Resources and Education
Elizabeth Hendrickson, MD
Michelle Pintea, MD, MPH
Lindsay Clukies, MD
In the United States, approximately 3,400 children die annually from unsafe sleep environments. These deaths include sudden unexpected infant deaths (SUID), suffocation, and strangulation. Numerous national educational campaigns have decreased the national SUID death rate. However, Missouri continues to experience high rates of preventable sleep-related deaths, with 103 in 2022 alone. Data reviewed from our institution showed providers rarely documented conversations about safe sleep. Our QI initiative sought to improve safe sleep screening at our level 1 pediatric trauma center and provide appropriate resources and education to families.
Our QI initiative took place at a single-center level 1 pediatric trauma center with approximately 50,000 ED visits per year. A safe sleep screening initiative was implemented with the SMART aim to increase the rate of safe sleep screening of all children under 12 months of age by providers by 75% from July 5, 2023 to March 1, 2024. We created a “Best Practice Advisory” (BPA) that flagged in the charts of all patients under 12 months of age and asked providers to answer a predeveloped, three-question screening set via an Epic “dot phrase.” At time of discharge, all patients under 12 months of age were provided with the American Academy of Pediatrics safe sleep guidelines, regardless of screening answers. If unsafe sleep practices were identified, providers were prompted to place a Social Work (SW) consult for necessary education or resources, including portable cribs at no cost. Our outcome measure was the total number of consults placed/cribettes given out.
In the 12 months prior to our initiative, 7,998 infants were seen in the ED. Of those, only 15 received SW consults for unsafe sleep practices and were provided cribettes. Following the implementation of our initiative, from July 2023 to March 2024, 5,808 infants were seen. Forty-eight were screened as practicing unsafe sleep and provided education and a cribette for home, a 340% increase in only nine months. This outcome was significant enough to justify continued implementation of this screening measure. Limitations found by analysis of process and balancing measures included increased patient volumes, the subtle location of the BPA in the chart, and noncompliance. These barriers were overcome by moving the BPA to a more visible location, sending reminders, and posting signage at provider workspaces reminding them of the initiative.
Injuries or deaths from unsafe sleep practices are preventable. Our initiative demonstrated that implementation of formalized screening in the ED setting leads to increased identification of infants at risk. While barriers to screening exist, it does increase rates of safe sleep counseling and improves access to resources to facilitate safe sleep practices.
1) Attendees will learn that there continues to be a high rate of preventable, sleep-rated death in Missouri and other individual states despite decreases in overall national SUID rates.
2) Attendees will learn the importance of documentation around safe sleep.
3) Attendees will learn the importance of a formalized screening processes aimed at decreasing preventable sleep-related deaths.