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Integrating Population Health Data on Violence Into the Emergency Department

A Feasibility and Implementation Study

Levas, Michael N. MD, MS; Hernandez-Meier, Jennifer L. PhD, MSW; Kohlbeck, Sara MPH; Piotrowski, Nancy RN; Hargarten, Stephen MD, MPH

doi: 10.1097/JTN.0000000000000361

Geocoded emergency department (ED) data have allowed for the development and evaluation of novel interventions for the prevention of violence in cities outside of the United States. First implemented in Cardiff, United Kingdom, collection of these data provides public health agencies, community organizations, and law enforcement with place-based information on assaults. The purpose of this study was to assess the feasibility of translating this model within the electronic medical record (EMR) in the United States. A new EMR module based on the Cardiff Model was developed and integrated into the existing ED EMR. Data were collected for all patients reporting an assaultive injury upon arrival to the ED. Emergency department nurses were subsequently recruited to participate in 2 surveys and a focus group to evaluate the implementation and to provide qualitative feedback to enhance integration. Nurses completed EMR questions in 98.2% of patients reporting to the ED over the study period. More than 90% of survey respondents were satisfied with their participation, and most felt that the questions were useful for clinical care (79/70%), were integrated well into workflow (89/90%), and were congruent with the ED and hospital goals and mission (93/98%). Focus group themes centered on ED culture, external factors, and internal workflow. It is feasible to implement place-based, assault-related injury-specific questions into the EMR with minimal disruption of workflow and triage times. Nurses, as key members of the ED team, are receptive to participating in the collection of population health data that may inform community violence prevention activities.

Department of Pediatrics, Section of Emergency Medicine (Dr Levas), Comprehensive Injury Center (Drs Hernandez-Meier and Hargarten and Ms Kohlbeck), and Department of Emergency Medicine (Dr Hargarten), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Wisconsin, Milwaukee (Dr Levas and Ms Piotrowski).

Correspondence: Michael N. Levas, MD, MS, Children's Corporate Center, Ste C550, 999 North 92nd St, Milwaukee, WI 53226 (

The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the Department of Justice.

The authors report no conflict of interest.

Copyright © 2018 by the Society of Trauma Nurses.