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Background/Objectives: 2023 Child Advocacy Center (CAC) accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant”. Prior to program implementation, scheduled Case Review occurred among the authors’ institution child abuse pediatricians (CAPs), but typical practice was to review cases upon CAP request. The authors’ institution faced practice standard implementation barriers of high case volumes and collaboration with multiple different CACs. Our primary aim was to increase peer review of abnormal exams from a baseline of 27% to 75% by March 15, 2023. Methods: Quality improvement methodology including a process map, fault tree, fishbone diagram, driver diagram, and PICK chart were used. Using published consensus of interpretation of exam findings, criteria were defined for review: trauma, indeterminate findings, medical conditions which could be mistaken for abuse, and visual signs of significant anogenital infections. Education was provided to CAPs on the new requirement for peer review. In the first PDSA cycle, CAPs completed a brief QR code linked REDCap form at the time of the exam to generate a case list for review and store data for CAC accreditation. Our outcome measure was completion of peer review of abnormal findings, our process measure was number of cases reported for review, and our balancing measure was CAP rating of satisfaction of balance of case types at case review. Results: Initial education resulted in a decrease to 19% of cases reviewed. Subsequent implementation of the QR code linked REDCap reporting process to generate case lists and designation of time for peer review improved results to 93% of cases reviewed. Balancing measure of CAP rating of case types at case review improved from 70% to 100%. Process measure monitoring showed a decrease in reported number of cases, triggering a manual chart review for compliance. Peer review rate decreased to 57% for the reviewed period. Exploration of process barriers revealed review of acute sexual assaults driving this decrease. Current overall outcome measure is 84% of indicated cases reviewed. Conclusions: The CAP team was able to make significant improvements to the outcome measure of peer reviewed abnormal exams. The QR code linked to a REDCap streamlined case tracking for case review and securely stores data for partner CAC accreditation requirements. Further PDSA cycles are planned to optimize process standardization and automation to increase sustainability of our results.

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Presented at the Ray E. Helfer Society 2024 Annual Meeting; April 7-10, 2024; Savannah, GA.

Improving Frequency of Peer Review of Abnormal Genital Exam Findings in Patients Undergoing Sexual Abuse Evaluation

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