Using Quality Improvement Methods to Enhance an Injury Prevention Program

Narmeen Khan, MD
Michael Levas, MD, MS
Brooke Cheaton, MBA
Rada Drca, MA, LPC
Pnina Goldfarb, PhD
Savannah Olsen, MSW, APSW

Beginning in December 2021, our tertiary care pediatric hospital in an urban, socioeconomically diverse city with high rates of firearm injuries implemented a study to improve the effectiveness of our hospital-based violence intervention program (HVIP) services. Despite the proven effectiveness of HVIPs in reducing injury recidivism, significant gaps were identified in the delivery of trauma-informed services to eligible families presenting to our emergency department (ED).

To address these gaps, our team conducted a comprehensive root cause analysis. This involved stakeholder interviews and surveys with nurses, providers, and Ujima staff (crime victim advocates - CVAs), as well as shadowing CVAs during patient interactions to better understand the challenges and needs.

Key interventions included: 1. Streamlining Referral Databases: Integration of various program referral databases to ensure they meet inclusion and exclusion criteria more efficiently. 2. Space for CVAs: Establishment of an ED touchdown space to increase the visibility and accessibility of Ujima staff. 3. EMR-Based Modifications: Creation of an automatic page-out system in the EMR, modeled after child life consults, with triggers for providers and more visible alerts for RNs (e.g., moving best practice advisories from triage to primary RNs). 4. Data Analysis: Collaboration with data analysts to create p-charts and c-charts for tracking referral rates over time. 5. Staff Education: Enhancing staff knowledge about Ujima through just-in-time resident training, RN newsletters, and the creation of an Ujima informational video accessible to patients post-ED discharge.

These interventions have been evaluated through multiple plan-do-study-act cycles, resulting in a significant increase in our HVIP referral rate from 54.3% to 95.4%.

This workshop will provide an overview of our HVIP improvement strategies and lead participants through the process of developing and evaluating interventions to enhance their own injury prevention programs. Participants will be divided into groups, each led by one of the presenters, to practice using root cause analysis to identify gaps and develop interventions for their program. Groups will reconvene to discuss their findings and share potential strategies for improving care delivery in their own settings.

1. Understand the components and significance of hospital-based violence intervention programs (HVIPs).
2. Learn how to conduct a root cause analysis to identify gaps in care delivery.
3. Gain insights into leveraging the electronic medical records to enhance program referrals and service delivery.
4. Reflect on how improved referral processes can enhance equity and access to trauma-informed care for all patients.