From Screening to Safety: A Hospital-Based Approach to Increasing Car Restraint Access and Use

Melissa Smith, LCSW, CPST

Motor vehicle crashes (MVCs) are one of the leading causes of pediatric injury and death in the United States. While it’s known proper restraint use reduces the risk of injury after a MVC, usage continues to remain a challenge for some families. Hospital-based Injury and Violence Prevention (IVP) programs can play a key role in identifying needs and providing appropriate restraints for children. We wanted to re-design our program to improve pediatric occupant protection outcomes by implementing universal occupant protection screening, creating more opportunities for intervention, and increasing staff knowledge on occupant protection hospital wide.

This program was developed at a tertiary care children’s hospital and includes both inpatient and outpatient pediatric populations.

In 2024, our injury prevention team began by mapping existing occupant protection workflows to better understand how inpatient and outpatient families were being screened and how car seats were distributed. This process involved close collaboration with nursing, supply chain, and philanthropy stakeholders. Gaps identified included inconsistent screening practices and variation in how restraints were distributed, as well as limited programming for older children and children with special healthcare needs (CSHCN).

As a result, inpatient and outpatient screening tools were developed for children 0-18 and paired with need-based intervention pathways. Because our trauma data shows the region’s highest fatalities are from unrestrained 13–19-year-olds, we wanted to ensure we were adequately screening longer than typically deemed necessary. Additional work focused on streamlining the ordering and distribution processes for restraints, as well as providing education to non-injury prevention staff to support screening and intervention.

Due to a concurrent electronic medical record (EMR) transition, data collection and analysis for some measures have been delayed. Ongoing evaluation will include development of key performance indicators (KPIs) and tracking process and outcome measures.

Following implementation, our hospital established a more consistent approach to screening and intervention across various care settings. In the first year, collaboration with supply chain and standardizing our ordering and distribution processes resulted in an estimated cost savings of $60,000.

Clearer workflows also reduced variation in practice and decreased the need for injury prevention staff involvement in many cases, allowing the program to serve additional children without needing to dedicate additional FTE.

Limited data are currently available due to the EMR transition; however, KPI development is expected by June 2026, with reporting beginning in summer 2026. Baseline data will be used to inform future quality improvement efforts.

A more consistent, systemwide approach to pediatric occupant protection improved efficiency, reduced costs, and strengthened program capacity. Hospital-based injury prevention programs are well positioned to identify gaps, support staff, and improve access to car seats and education for families. Continued evaluation will help guide future improvements and expand the impact of this work on preventing pediatric injury.

1. Talk through common gaps in pediatric occupant protection that can show up in hospital settings.
2. Use a simple, consistent approach to screen for adequate restraints and respond with appropriate interventions.
3. Take away practical ideas for improving workflows and expanding access to car seats and seat belt education through collaboration across teams.