WIP 19 - Universal Intimate Partner Violence Education in a Pediatric Emergency Department: a Quality Improvement Initiative

Publication Number: WIP 19.7488

Dhatri Abeyaratne, Yale School of Medicine, New Haven, CT, United States; Marcie Gawel, Yale-New Haven Hospital, New Haven, CT, United States; Ashley Starr Frechette, Connecticut Coalition Against Domestic Violence, longmeadow, MA, United States; Misty Decristofaro, Yale-New Haven Children's Hospital, wallingford, CT, United States; Caitlyn C. Poach, Yale-New Haven Children's Hospital, Wallingford, CT, United States; Nicole Carter, Yale-New Haven Children's Hospital, Prospect, CT, United States; James Dodington, Yale University School of Medicine, NEW HAVEN, CT, United States; Kimberly A. Randell, Children's Mercy Kansas City, Kansas City, MO, United States; Gunjan Tiyyagura, Yale School of Medicine, New Haven, CT, United States

Background: One in four women and one in seven men experience intimate partner violence (IPV) in their lifetime, and an estimated 15 million US children are exposed to IPV annually. Adult IPV survivors are more likely to seek health care for their children than to contact criminal justice or social services. Evidence suggests that universal IPV screening, with resources offered only after positive screens, does not reduce IPV or improve quality of life. Further, positive rates from universal IPV screening are significantly lower than the national IPV prevalence. Thus, the American Academy of Pediatrics now recommends a universal IPV education (UE-IPV) approach that informs all families about IPV resources, regardless of visit reason or disclosure.

Objective: To increase nurse-initiated UE-IPV delivery to caregivers and adolescent patients in one pediatric emergency department (PED) from 0% to 50% over 12 months.

Design/Methods: Using the Model for Improvement approach, we formed a multidisciplinary team including PED providers, nurse leadership, informatics representatives, and an IPV advocate. Pre-implementation survey data from 41 caregivers revealed that the frequency of discussion and resource dissemination about IPV in the PED was 0% at baseline. We conducted initial interviews with frontline nurses to gather feedback on optimizing UE-IPV delivery. Using this data, we identified key drivers for implementing UE-IPV in the PED, including nursing buy-in, leadership endorsement, and a user-centered UE-IPV process. We used Plan-Do-Study-Act cycles to test and refine interventions, including nursing education (tip sheets, huddles, emails, presentations from IPV experts); meetings with nursing leadership to engage our network of champions; academic detailing; and updates to the electronic health record workflow. Using weekly data over 12 months beginning January 2024, we will assess the percentage of PED caregivers or adolescent patients who received UE-IPV using a statistical control (p) chart. As quality improvement work, this study was exempt from IRB review (#2000036645).