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A pilot quality improvement program to increase pediatrician injury anticipatory guidance

Gittelman, Michael A. MD; Denny, Sarah MD; Anzeljc, Samantha PhD; FitzGerald, Mike PhD; Arnold, Melissa Wervey

Journal of Trauma and Acute Care Surgery: September 2015 - Volume 79 - Issue 3 - p S9–S14
doi: 10.1097/TA.0000000000000672
Original Articles

BACKGROUND Because of a lack of time and training, many pediatricians often address few, if any, injury topics during well-child visits. The project goal was to increase the injury anticipatory guidance topics covered by pediatricians during well-child visits by offering screening tools and focused talking points through a quality improvement learning collaborative.

METHODS Screening tools were developed and pretested. Pediatric practices, recruited through the Ohio American Academy of Pediatrics, were taught quality improvement theory and injury prevention strategies at a learning session. Pediatricians worked to implement screening tools and talking points into every well-child visit for children 1 year or younger. Monthly, providers reviewed five random charts for each of the six well-child visits for screening tool use and age-appropriate injury prevention discussion. Providers received maintenance of Certification IV credit.

RESULTS Sixteen pediatricians (six practices) participated. Screening tool use increased from 0% to 97.2% in just 3 months of the program. For each well-child care visit, injury prevention discussion increased by 89.5% for newborn visit, 88.1% for 2-month, 93.6% for 4-month, 94.0% for 6-month, 88.1% for 9-month, and 90.3% for 12-month-old babies. During the quality improvement program, discussion points for all children 1 year or younger increased for all age-appropriate topics. The greatest percent increase in discussions occurred with water safety (from 10.8% to 95.7%, n = 231), play safety (from 17.9% to 93.5%, n = 154), and supervision safety (from 20.8% to 94.4%, n = 251). More commonly addressed topics also had a significant increase in discussions: sleep safety (from 48% to 93.9%, n = 262), choking (from 44.7% to 95.4%, n = 172), and car safety (from 41.2% to 80.1%, n = 332).

CONCLUSION Participation in a maintenance of Certification IV quality improvement program within pediatric offices can increase screening and discussion of injury anticipatory guidance.

LEVEL OF EVIDENCE Therapeutic/care management study, level IV.

From the Division of Emergency Medicine (M.A.G., M.F.), Cincinnati Children’s Hospital Medical Center, Cincinnati; Division of Emergency Medicine (S.D.), Nationwide Children’s Hospital, Columbus; and Ohio Chapter of the American Academy of Pediatrics (S.A., M.W.A.), Worthington, Ohio.

Submitted: October 21, 2014, Revised: January 9, 2015, Accepted: January 18, 2015, Published online: June 30, 2015.

This study was part of oral presentation at the Annual Meeting of the Ambulatory Pediatric Association, May 2014, in Vancouver, Canada, and was accepted for oral presentation at the 19th Annual Injury Free Coalition for Kids Conference, December 5–7, 2014, in Fort Lauderdale, Florida.

Address for reprints: Michael A. Gittelman, MD, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2008 Cincinnati, OH 45229; email:

© 2015 Lippincott Williams & Wilkins, Inc.