Use of a safety resource center in a pediatric emergency department

Home safe home: Evaluation of a childhood home safety program

BACKGROUND

The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age.

METHODS

A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level.

RESULTS

A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate.

CONCLUSION

Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age.

LEVEL OF EVIDENCE

Therapeutic/care management study, level V.

A national, cross-sectional survey of children's hospital-based safety resource centres

OBJECTIVE

To describe the location, staffing, clientele, safety product disbursement patterns, education provided and sustainability of safety resource centres (SRCs) in US children's hospitals.

METHODS

A cross-sectional survey was distributed to children's hospital-based SRC directors. Survey categories included: funding sources, customer base, items sold, items given free of charge, education provided and directors' needs.

RESULTS

32/38 (84.2%) SRC sites (affiliated with 30 hospitals) completed the survey. SRCs were in many hospital locations including lobby (28.1%), family resource centres (12.5%), gift shop/retail space (18.8%), mobile units (18.8%) and patient clinics (12.5%). 19% of respondents reported that their SRC was financially self-sustainable. Sales to patients predominated (mean of 44%); however, hospital employees made up a mean of 20% (range 0-60%) of sales. 78.1% of SRCs had products for children with special healthcare needs. Documentation kept at SRC sites included items purchased (96.9%), items given free of charge (65.6%) and customer demographics (50%). 56.3% of SRCs provided formal injury prevention education classes. The SRCs' directors' most important needs were finances (46.9%), staffing (50%) and space (46.9%). All of the directors were 'somewhat interested' or 'very interested' in each of the following: creation of a common SRC listserv, national SRC data bank and multisite SRC research platform.

CONCLUSIONS

SRCs are located in many US children's hospitals, and can be characterised as heterogeneous in location, products sold, data kept and ability to be financially sustained. Further research is needed to determine best practices for SRCs to maximise their impact on injury prevention.

A comprehensive approach to pediatric injury prevention in the emergency department

Injury is the leading cause of pediatric mortality and long-term disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a "teachable moment" because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. However, EDs can also provide additional information and services beyond counseling to prevent injuries. These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts.

An evaluation of a dog bite prevention intervention in the pediatric emergency department

BACKGROUND

This study aimed to determine the efficacy of a video-based dog bite prevention intervention at increasing child knowledge and describe any associated factors and to assess the acceptability of providing this intervention in a pediatric emergency department (PED).

METHODS

This cross-sectional, quasi-experimental study enrolled a convenience sample of 5-year-old to 9-year-old patients and their parents, presenting to a PED with nonurgent complaints or dog bites. Children completed a 14-point simulated scenario test used to measure knowledge about safe dog interactions before and after a video intervention. Based on previous research, a passing score (≥ 11/14) was defined a priori. Parents completed surveys regarding sociodemographics, dog-related experiential history, and the intervention.

RESULTS

There were 120 child-parent pairs. Mean (SD) child age was 7 (1) years, and 55% were male. Of the parents, 70% were white, two thirds had higher than high school education, and half had incomes less than $40,000. Current dog ownership was 77%; only 6% of children had received previous dog bite prevention education. Test pass rate was 58% before the intervention and 90% after the intervention. Knowledge score increased in 83% of children; greatest increases were in questions involving stray dogs or dogs that were fenced or eating. Younger child age was the only predictor of failing the posttest (p < 0.001). Nearly all parents found the intervention informative; 93% supported providing the intervention in the PED.

CONCLUSION

Child knowledge of dog bite prevention is poor. The video-based intervention we tested seems efficacious at increasing short-term knowledge in 5-year-old to 9-year-old children and is acceptable to parents. Parents strongly supported providing this education.

Injury prevention: opportunities in the emergency department

Because injury is the leading cause of morbidity and mortality in young patients, emergency departments have a significant opportunity to provide injury-prevention interventions at a teachable moment. The emergency department has the ability to survey injuries in the community, use the hospital setting to screen patients, provide products, offer resources to assist families within this setting to change their risky behaviors, and connect families to community resources. With a thoughtful, collaborative approach, emergency departments are an excellent setting within which to promote injury prevention among patients and families.

Is an emergency department encounter for a motor vehicle collision truly a teachable moment?

BACKGROUND

Some have suggested that a pediatric emergency department (PED) visit for an injury represents a "teachable moment." Our aim was to determine if a motor vehicle collision (MVC) instigates greater change in booster seat use compared with children presenting for non-injury-related complaints.

METHODS

A prospective pilot study of children 4 years to 8 years who never used a booster seat and were in a minor MVC were compared with children presenting to the PED for non-injury-related complaints. After completing a survey of demographics and knowledge about booster seats, all parents received brief, standardized counseling about booster seats. Two weeks after the PED visit, follow-up telephone calls were made to assess behavior change.

RESULTS

Sixty-seven youth were enrolled (37 MVC group, 30 controls). Initially, 65 (97%) used a seat belt alone (36 MVC, 29 controls); the rest were unrestrained. There was no difference between the groups in mean age, sex of child, or insurance type. Significantly more families in the MVC group claimed that they would get a booster seat after their PED encounter (46% vs. 19%, p = 0.02) and their child would consistently use a booster seat (54% vs. 23%, p = 0.01). At follow-up, 45 families (67%) were reached (25 cases [68%] and 20 controls [67%]). There was no significant difference between the groups in having a booster seat at follow-up (12 cases [48%] and 9 controls [45%]) and reports of booster seat use more than 75% of the time (9 cases [36%] and 7 controls [35%]).

CONCLUSION

A minor MVC did not serve as a teachable moment to entice families to consistently use a booster seat more than families presenting to a PED for non-injury-related complaints. However, more than one third of the families who learned about booster seats in the PED reported using a booster seat regularly.

LEVEL OF EVIDENCE

Therapeutic study, level II.

Dog bite prevention: an assessment of child knowledge

OBJECTIVES

To determine what children know about preventing dog bites and to identify parental desires for dog bite prevention education.

STUDY DESIGN

This cross-sectional study sampled 5- to 15-year-olds and their parents/guardians presenting to a pediatric emergency department with nonurgent complaints or dog bites. The parent/guardian-child pairs completed surveys and knowledge-based simulated scenario tests developed on the basis of American Academy of Pediatrics and Centers for Disease Control and Prevention dog bite prevention recommendations. Regression analyses modeled knowledge test scores and probability of passing; a passing score was ≥11 of 14 questions.

RESULTS

Of 300 parent/guardian-child pairs, 43% of children failed the knowledge test. Older children had higher odds of passing the knowledge test than younger children, as did children with white parents vs those with nonwhite parents. No associations were found between knowledge scores and other sociodemographic or experiential factors. More than 70% of children had never received dog bite prevention education, although 88% of parents desired it.

CONCLUSIONS

Dog bites are preventable injures that disproportionately affect children. Dog bite prevention knowledge in our sample was poor, particularly among younger children and children with nonwhite parents. Formal dog bite prevention education is warranted and welcomed by a majority of parents.