Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Jennifer Hansen, MD
Start Date
8-5-2023 11:30 AM
End Date
8-5-2023 1:30 PM
Presentation Type
Abstract
Description
Problem Statement/Question: Child Advocacy Centers (CACs) coordinate child abuse MDTs, and 2023 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.” Scheduled Case Review occurs among Children’s Mercy child abuse pediatricians (CAPs), but current practice is to review cases only upon CAP request.
Background/Project Intent (Aim Statement): Appropriate interpretation of sexual abuse exam findings is crucial for accurate diagnosis and provision of medical information to multidisciplinary child protection teams (MDTs). Medical mimics and normal anatomic variants exist which may be misinterpreted as trauma. Peer review is the emerging standard to ensure diagnostic accuracy and MDT response. Our primary aim was to increase completion of peer review of abnormal exams from a baseline of 15% to 75% by March 15, 2023.
Methods (include PDSA cycles): Quality improvement methodology was used to increase frequency of peer review of abnormal exam findings. Based on published consensus of interpretation of exam findings, criteria were defined for review: findings caused by trauma, visual signs of significant anogenital infections, and findings of medical conditions which could be mistaken for abuse. Education was provided to CAP attendings and fellows on the new accreditation standards with requirement for peer review. In the first PDSA cycle, a form was completed by CAPs at the time of the exam to generate a list of cases for the next session. Our outcome measure was completion of peer review of abnormal findings, and our process measure was reporting of abnormal exams for case review.
Results: Initial intervention resulted in peer review of 100% of submitted cases during the first two weeks, though overall case numbers were low. Ongoing data collection will occur with data to be portrayed in a run chart.
Conclusions: By currently available preliminary data, the CAP team was able to make modest improvements to the percent of abnormal exams undergoing peer review. This intervention remains under investigation for continued improvement and development of subsequent PDSA cycles. Future directions include optimizing process standardization in workflow and automation to increase sustainability.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Improving frequency of peer review of abnormal genital exam findings in patients undergoing sexual abuse evaluation
Problem Statement/Question: Child Advocacy Centers (CACs) coordinate child abuse MDTs, and 2023 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.” Scheduled Case Review occurs among Children’s Mercy child abuse pediatricians (CAPs), but current practice is to review cases only upon CAP request.
Background/Project Intent (Aim Statement): Appropriate interpretation of sexual abuse exam findings is crucial for accurate diagnosis and provision of medical information to multidisciplinary child protection teams (MDTs). Medical mimics and normal anatomic variants exist which may be misinterpreted as trauma. Peer review is the emerging standard to ensure diagnostic accuracy and MDT response. Our primary aim was to increase completion of peer review of abnormal exams from a baseline of 15% to 75% by March 15, 2023.
Methods (include PDSA cycles): Quality improvement methodology was used to increase frequency of peer review of abnormal exam findings. Based on published consensus of interpretation of exam findings, criteria were defined for review: findings caused by trauma, visual signs of significant anogenital infections, and findings of medical conditions which could be mistaken for abuse. Education was provided to CAP attendings and fellows on the new accreditation standards with requirement for peer review. In the first PDSA cycle, a form was completed by CAPs at the time of the exam to generate a list of cases for the next session. Our outcome measure was completion of peer review of abnormal findings, and our process measure was reporting of abnormal exams for case review.
Results: Initial intervention resulted in peer review of 100% of submitted cases during the first two weeks, though overall case numbers were low. Ongoing data collection will occur with data to be portrayed in a run chart.
Conclusions: By currently available preliminary data, the CAP team was able to make modest improvements to the percent of abnormal exams undergoing peer review. This intervention remains under investigation for continued improvement and development of subsequent PDSA cycles. Future directions include optimizing process standardization in workflow and automation to increase sustainability.
