ACT II. Medical Record Systems and Child Abuse Reports UCLA Children s Hospital Central California Kaiser Southern California Rady Children s Hospital

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Darrell Armstrong
8 years ago
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1 ACT II Medical Record Systems and Child Abuse Reports UCLA Children s Hospital Central California Kaiser Southern California Rady Children s Hospital

2 SCENE I UCLA Health System

3 Current state Collect data from internal SCAN Consultation form Contains demographic and abuse related information Data entered into Excel spreadsheet Data used for Education SCAN team members Reporting to other services Quality improvement Barriers Labor intensive Difficulty maintaining database due to time constraints

Data used for Education SCAN team members Reporting to other services Quality

4 EMR in progress Moving to Epic Systems Plan to include all abuse reporting and examination forms: 8572 Suspected Child Abuse Report CalEMA 900 suspected physical abuse CalEMA 925, 930 sexual assault CallEMA 502 domestic violence Newborn Risk Assessment SOC 341 (Elder Abuse) OES 920 Suspicious Injury Report Build concerns: PHI/confidentiality Alerts for suspected child abuse cases Defining the legal medical record

502 domestic violence Newborn Risk Assessment SOC 341 (Elder Abuse) OES 920 Suspicious Injury Report

5 SCENE II Children s Hospital Central California

6 BETTER PROTECTION FOR YOUNG INJURED CHILDREN: AUTOMATING/MANAGING HOSPITAL CHILD ABUSE REPORTS C. Leanne Kozub, RN, CLNC The Guilds Child Abuse Prevention & Treatment Center Children s Hospital Central California Madera, CA

7 Details! To track SCAR s = Excel spreadsheet and manual entry Policy dictates that copies of SCAR s go to medical records and Child Advocacy Clinic Tracking basics (MR, age, type of injury, reporter, location) Roughly been doing since Streamlined in 2009.

8 SCAR Totals By Year

9 Suspected Child Abuse Reports (SCAR s continued) By auditing digital medical records (Chart Maxx), all charts that have the document type Suspected Child Abuse can be pulled.

10 DATA!

11 Lessons Learned the Hard Way 13 month old visits the ER for an arm fracture. Mechanism matches the reported injury. Mother appropriate. Arm casted and child discharged home. No social work intervention, no child abuse work up. One week later, 1 month sibling admitted for ALTE. Workup indicates abusive head trauma. Child dies in PICU. 13 month old evaluated in Child Advocacy Clinic at the same time the 1 month is admitted. Rib fractures were found and were in different stages of healing than arm fracture.

One week later, 1 month sibling admitted for ALTE. Workup indicates abusive head trauma. Child dies in PICU.

12 Lessons Learned the Hard Way Upon records review of both children s medical records, found red flags that could have warranted Social Worker referral. Individual interventions were appropriate. Policies were followed. Still, child died.

13 SCENE III Kaiser Permanent Southern California

14 Preventing And Detecting Suspected Child Abuse : How The EMR Can Help Us Snigdha Das MD Pediatric Hospitalist Kaiser Los Angeles Medical Center Regional SCAN Co-Chair for Kaiser Permanente Southern California

Hospitalist Kaiser Los Angeles Medical Center

15 Southern California Kaiser Permanente Facts

16 Pediatric Services

17 Smart Set Gives guidelines for orders STI medications Labs for specific concerns (bruising, fracture/rickets, abdominal trauma, STI Imaging (Complete Osseous Survey, CT, MRI) Consults MSW consult is PRE-SELECTED Pediatrics, GYN Link to Family Violence Prevention Website Definitions of abuse Warning signs Behavioral signs Link to medical center specific website Medical Center specific contacts (MD, MSW) Links to forms for reporting Phone numbers for local reporting agency Local assessment center information

Prevention Website Definitions of abuse Warning signs Behavioral signs Link to medical center specific website Medical Center

18 Internal ICD-9 Codes Enter for all reported cases Suspected Emotional Child Abuse Mandatory Report Suspected Neglect Child Abuse Mandatory Report Suspected Physical Child Abuse Mandatory Report Suspected Emotional Child Abuse Mandatory Report Suspected Emotional Child Abuse Mandatory Report Pull for data on reporting

Physical Child Abuse Mandatory Report Suspected Emotional Child Abuse Mandatory

19 Goals Use of Internal ICD-9 codes for daily Safety Net report Use of Internal ICP-9 codes to monitor management (ordering of proper tests and consults) Smart Phrase Best Practice Alerts Quality Project: Scoring tool Incorporation of digital photographs to the medical record.

and consults) Smart Phrase Best Practice Alerts Quality Project:

20 SCENE IV Rady Children s Hospital

21 Challenge Two year transition to Epic EMR Emergency Department: August 2009 Primary Care October 2009: July 2010 Specialty Clinics: February 2010 July 2011 Inpatient: September 2011 Prior to Epic reports filed on paper or in legacy system Acute sexual assault patients not captured in child abuse reporting With ED go live created child abuse reporting form within Epic but didn t allow for data capture Move all clinical child abuse documentation into the EMR

22 Plan Recreate OES 925, 930 and 900 in Epic using discrete data elements to allow for data capture Create child abuse reporting form that: Worked in all Epic environments Could be used by any clinician Captured all patients who had abuse report filed and who were seen for an encounter relative to that abuse Allowed for data capture Protected child abuse records from being inappropriately released Create child abuse dashboard

23 Process

24 Process

25 Process

27 Daily reports

28 Consult reports

29 Reports

30 Outcome Successes All areas using the same reporting method Daily reports allow for timely case review Sexual assault/molest cases captured Created annual report Able to run simple daily and monthly reports myself Remaining issues Data analysis difficult with current format Report writers with conflicting priorities Create dashboard incorporating trauma/injury data

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT SUSPECTED VICTIMS OF ABUSE AND NEGLECT (PATIENTS PRESENTING TO LSUHSC)

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT SUSPECTED VICTIMS OF ABUSE AND NEGLECT (PATIENTS PRESENTING TO LSUHSC) Purpose: To establish guidelines for all hospital personnel to follow