38 - Increasing the use of submersion injury prevention discharge instructions from a pediatric emergency department

Poster Number: 38
Publication Number: 38.406

Lauren E. Van Woy, Rady Children's Hospital San Diego, San Diego, CA, United States; Amy Bryl, Rady Children's Hospital San Diego, San Diego, CA, United States; Matthew Kline, BronxCare, Brooklyn, NY, United States; Elise Zimmerman, Rady Children's Hospital San Diego, San Diego, CA, United States

Background: Submersion injury is the leading cause of injury and death in children 1 to 4 years of age in the United States (US) and the third leading cause of injury and death in children and adolescents 5 to 19 years of age. Experts recommend multiple layers of protection to prevent submersion injury, including swim lessons, cardiopulmonary resuscitation (CPR) lessons, fencing, life jackets, and supervision.

Objective: To create standardized submersion injury prevention instructions and increase their use by pediatric emergency physicians from 0% to 50% in patients with submersion injury discharged from the emergency department (ED) from September 2020 to October 2021.

Design/Methods: We reviewed the content of discharge instructions given to patients with submersion injury from May 2019 to August 2020. In September 2020, we developed and incorporated standardized submersion injury discharge instructions into the electronic medical record (EMR) in collaboration with physicians, nursing, and informatics. Our primary measure was assessed by reviewing the charts of all discharged patients with submersion injury from September 2020 to October 2021 for use of the new instructions. Interventions to increase instruction use included posters in ED work areas, emailing tip sheets on how to access instructions in the EMR, education during staff meetings, and highlighting the instructions in our monthly newsletter. To evaluate the impact of the instructions, patients' families were contacted within 1 month of discharge to assess whether they had signed up for swim or CPR lessons. We also asked families 5 knowledge-based questions regarding submersion injury prevention (Table 1). We used statistical process control to examine changes in measures over time and Fisher’s exact test to compare caregiver knowledge between those receiving and not receiving the instructions.

Results: Physician’s use of submersion injury-specific discharge instructions increased from 0% to 50% from September 2020 to October 2021 (Figure 1). Caregivers’ likelihood of signing up for swim and CPR lessons increased from 0.36 (1.64, 0) to 0.62 out of 2 (1.982, 0) during that time. Caregivers’ knowledge on submersion injury prevention in those that received the standardized instructions (74%) was greater than those that did not (39%) (p=0.02). Conclusion(s): Submersion injury prevention information can easily be incorporated into an EMR as discharge instructions. Increased physician use of these instructions can be achieved through educational and EMR interventions. We are collaborating with hospital medicine to implement the instruction use hospital wide. 
Figure 1: P ChartPercent of Discharged Submersion Injury Patients Who Received Injury Prevention Discharge Instructions
Table 1:Questions to Assess Caregiver Knowledge of Submersion Injury Prevention