Every day in the U.S., more than four children die because of abuse. Of those, more than 70 percent are 2 years old or younger.
In response to this issue, two UPMC physicians are developing and disseminating a child abuse clinical decision support (CA-CDS) system within the electronic health record (EHR). The goal is to rapidly identify potential abuse that might otherwise be overlooked in a busy emergency department. The development team includes Dr. Srinivasan Suresh,pediatric emergency physician and chief medical information officer at Children’s Hospital of Pittsburgh of UPMC, and Dr. Rachel Berger, chief of the Children’s Child Advocacy Center and the director of child abuse research at the Safar Center for Resuscitation Research at the University of Pittsburgh.
“Emergency physicians care for patients who present with a wide spectrum of symptoms,” Suresh said. “The signs of abuse are not always clear. Triggers and visual alerts in an EHR can address this gap.”
The CA-CDS system, which includes a trigger system, provider alerts and a physical abuse order set, has been successfully developed and deployed at Children’s. When a child presents to the emergency department with a physical injury that could have come as a result of abuse, an alert pops up in the EHR to immediately notify the physician and the rest of the care team, bringing the possibility of abuse to their attention.
“The aim of this trigger is to increase the sensitivity of our suspicion for physical child abuse,” Suresh said.
Since the system is standardized, it can also eliminate biases.
“Our gut is not always right as it relates to child abuse,” Berger said. “By standardizing and reminding people to think about abuse, racial and other disparities can be decreased.”
Originally funded by the Patient-Centered Outcomes Research Institute, the CA-CDS project recently received a $99,900 grant from The Beckwith Institute, specifically through its Bench at the Bedside program. Bench at the Bedside allows doctors to take what they know and transform it into ideas that will further improve clinical practice.
The grant has helped the researchers expand the value of the toolkit.
“We have successfully implemented the decision support tool here in Pittsburgh,” Suresh said. “This grant now enables us to integrate the toolkit into the EHRs of a few large children’s hospitals across the country.”
“This is a powerful tool in helping doctors and nurses recognize the signs of abuse, intervene in a timely fashion and avoid having to treat the same children repeatedly for abuse,” Berger said. “The children are vulnerable and don’t have a voice. It’s our job to protect them.”
To learn more about The Beckwith Institute or the grants the organization offers, visit www.beckwithinstitute.org.