Increasing a hospital-based violence intervention program's referrals for children and families in a pediatric emergency department.

Abstract

Background: Our pediatric tertiary care hospital sees a high rate of firearm injuries. Hospital-based violence intervention programs (HVIPs) reduce violent injury recidivism rates in victims. However, significant gaps exist in the delivery of trauma-informed services to families. Our specific aim was to increase our HVIP referral rate by 20% over a 12-month time frame for children seen for interpersonal violence in the emergency department (ED).

Methods: Our quality improvement study was done at a pediatric tertiary care hospital and encompassed patients 0 to 18 years of age who presented to our ED for assault-related concerns from December 26, 2021 to June 23, 2024. The primary outcome measure was percentage of HVIP-eligible patients who received a referral from the ED. We conducted a root cause analysis by interviewing stakeholders including HVIP staff, ED providers, nurses, and social workers to understand gaps in the referral process. Key drivers included electronic medical record (EMR) trigger tools for referral placement, accessibility of HVIP staff, and staff knowledge of HVIP eligibility and services. We integrated three main EMR-based interventions on June 15, 2023 that triggered referrals to the HVIP.

Results: Our ED HVIP referral rate during the pre-intervention period (December 26, 2021 to June 15, 2023) was 53.6%. During our post-intervention phase (June 15, 2023 to June 23, 2024), the referral rate reached and sustained at 93.5%, a 74.4% increase.

Conclusions: We identified a large percentage of missed HVIP-eligible referrals and developed interventions that significantly increased our referral rate. However, this did not translate into increased enrollment, indicating the need for additional efforts.