Implementation of a Safety Checklist and Guidance Tool During Well-Child Visits

Abstract

Problem: Unintentional injuries are the leading cause of morbidity and mortality in pediatrics. Providers have difficulty with injury screening and prevention counseling during well visits due to a lack of time and nonstandard screening methods. Purpose: To implement the pre-visit electronic Safety Checklist and Safety Guidance Tool developed by CHADIS (Comprehensive Health and Decision Information Systems), at a pediatric clinic as an efficient and comprehensive approach to injury screening and the delivery of focused anticipatory guidance to caretakers. Methods: A pediatric practice elected to participate in a quality improvement initiative and implement the safety tool over a 15-week period. Age-specific safety checklists were auto-assigned by CHADIS to eligible patients two weeks prior to their well visit. Following checklist completion by caretakers, evidence-based safety guidance was electronically provided, focusing on topics of perceived risk based on results. Providers reviewed results in preparation for well visits to provide focused guidance to families. Data was collected weekly during the implementation period to determine the percentage of assigned safety checklists and the number of checklists completed. Results: Of the 418 eligible patients, 23% (n=95) were registered with CHADIS and auto-assigned the safety tool. Of those assigned the tool, 84% (n=80) of these caretakers accessed the checklist through their patient portal and 17% (n=14) of these caretakers submitted completed safety checklists. Providers reviewed 100% of the submitted checklists prior to the patient’s visit. Conclusions: Adoption of the Safety Checklist and Guidance Tool into the clinic’s workflow processes was achieved within a 15-week period and was well received by providers and participating caregivers given their familiarity with utilizing CHADIS’s screening tools routinely in their clinic. Providers felt that the safety tool’s content facilitated visits and offered thorough injury risk assessment and focused guidance to families without interrupting workflow processes during well visits. Barriers included getting patients registered with CHADIS and having caretakers complete and submit the safety checklists during implementation. Future quality improvement initiatives will have better success if patients are auto-registered and the implementation trial period is longer to make it possible to identify and mitigate the barriers to caretakers completing the CHADIS registration process.