Enhancing Follow-up Care of Sexually Assaulted Children: Outcomes of a Forensic Nurse Care Coordination QI Initiative.

Background: Nurse care coordination for children and adolescents experiencing acute sexual assault is rarely done but could yield positive outcomes. Demonstrating the value of forensic nurse care coordination (RNCC) is challenging: No benchmarks or metrics existed to measure the impact of RNCC on patient care or outcomes. Hours could be tracked, contact attempts could be tallied, but evaluating the value and outcomes of a forensic RNCC was lacking.

Methods: Using quality improvement (QI) methodology, we identified measures to quantify the impact of care coordination by a forensic nurse for pediatric and adolescent patients who had experienced acute sexual assault. Measures included attending follow-up clinic, obtaining follow-up labs at 6 weeks and 3 months post-assault, and patient concordance with an established clinical care follow-up pathway. We implemented the forensic RNCC between October 2022 and June 2023, with pre- and post-QI intervention chart review to establish baseline and post-QI outcome measures.

Results: The forensic RNCC role was successfully implemented. All measures demonstrated improvement from pre- to post-intervention. Clinic follow-up increased from 70% to 98% of patients. Patients obtaining screening labs 6 weeks post-assault increased from 53% pre-intervention to 92% post-intervention. The pathway recommends patients obtain labs 3 months post-assault as well, and we saw an increase from 67% to 89% of the post-intervention group obtaining labs at 3 months. Overall concordance to the system's evidence-based clinical care pathway increased from 45% to 83% of the post-intervention group.

Conclusions: This QI initiative achieved measurable improvement in patient care and outcomes by leveraging the expertise of a forensic RNCC.