Implementation of a Comprehensive Program to Improve Child Physical Abuse Screening and Detection in the Emergency Department



      Children often present to the emergency department for treatment of abuse-related injuries. ED providers—including emergency nurses—do not consistently screen children for abuse, which may allow abuse to go undetected and increases the risk for reinjury and death. ED providers frequently cite lack of knowledge or confidence in screening for and detecting child abuse. The purpose of this quality improvement project was to implement an evidence-based screening program that included provider education on child physical abuse, a systematic screening protocol, and use of the validated Escape Instrument.


      A pre-test/post-test design was used to measure the effect of a 20-minute educational session on ED provider knowledge and confidence in screening for and recognizing child physical abuse. Diagnostic codes for child physical abuse were analyzed for a 30-day period before and after implementation of the screening protocol. A final survey was administered 4 months after project implementation to evaluate the impact of the screening program.


      There were significant increases in provider knowledge and confidence scores for child physical abuse screening and recognition (P < .001). There was no difference in providers’ diagnostic coding of child physical abuse. The educational session and Escape Instrument were the most reported screening facilitators, and transition to a new electronic health system was the most reported barrier.


      The results of this project support comprehensive screening programs to improve ED provider knowledge and confidence in screening for and recognizing child physical abuse. Future research should focus on the impact of screening on the diagnosis and treatment of child physical abuse.
      Contribution to Emergency Nursing Practice
      • The current state of scientific knowledge on child physical abuse indicates that early detection of abuse reduces the rate of subsequent reinjury and death by as much as 50%.
      • The main findings of this research are that educational sessions, combined with a systematic screening protocol and the validated Escape Instrument, increase ED health care providers’ knowledge and confidence in screening for and recognizing child physical abuse.
      • Key implications for emergency nursing practice from this research are great. Emergency nurses are uniquely positioned to improve the detection of nonaccidental childhood injuries and reduce the rate of subsequent reinjury and death by implementing comprehensive child physical abuse screening programs in their facilities.

      Key words

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      Sheri M. Carson is Clinical Instructor and Pediatric Nurse Practitioner, The University of Arizona College of Nursing, Tucson, AZ.
      This quality improvement project was completed in partial fulfillment of requirements for the Doctor of Nursing Practice (DNP) degree at Arizona State University in Phoenix, AZ.