718 - A Quality Improvement Initiative to Increase Injury Prevention Consults for Water Safety in High Risk Patients in the Pediatric Emergency Department

Publication Number: 3695.718

Jacob Levy, Phoenix Children's Hospital - - Phoenix, AZ, Phoenix, AZ, United States; Claudia Yeung, Phoenix Children's Hospital, Phoenix, AZ, United States; Karen Yeager, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States; Angelica Baker, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Drowning is a leading cause of pediatric death and injury; in 2020 it surpassed birth defects as the leading cause of death for U.S. children ages 1-4. Children with autism or epilepsy are at increased risk for drowning. Injury prevention (IP) counseling is an effective strategy, and our hospital has a dedicated IP team for water safety education. From May to September 2023, 306 emergency department (ED) patients met high-risk criteria (ages 1-4 with autism or epilepsy, or any age presenting with drowning), yet only one water safety consult was placed. We developed an intervention to improve timely identification of high-risk patients and placement of IP consults during the ED course.

Objective: To increase the percentage of eligible patients seen at our primary ED site receiving a completed water safety IP consult from < 1% to 20% by December 2025 and sustain improvements for 12 months.

Design/Methods: We used sequential Plan-Do-Study-Act (PDSA) cycles to improve recognition and referral for water safety counseling. High-risk eligibility criteria were defined as a chief complaint of drowning or ages 1-4 with history of autism or epilepsy; exclusions included emergency severity index (ESI) level 1 and spastic cerebral palsy. Interventions included division-wide education, targeted reminders and a Best Practice Advisory (BPA) in the electronic health record to alert providers to high-risk patients (Figure 1). The primary outcome was the percentage of high-risk patients at our primary ED site with a completed IP consult. Process measures included consults placed and BPA firing for eligible encounters across all ED sites.

Results: A baseline shift was identified in the outcome measure, with the median percentage of high-risk patients receiving a completed water safety consult increasing from 0% to 0.95% (mean 2.9%) following sequential PDSA interventions and subsequent BPA implementation (Figure 2). Although completion remains below the 20% target, this represents the first sustained improvement since project initiation. Baseline shifts were also identified in the process measures. The median percentage of consults placed increased from 0% to 5.05% (Figure 3). BPA firing rates increased from < 10% early post-launch to >75% by September 2025, indicating enhanced system reliability and capture of eligible patients.

Conclusion(s): Education combined with a targeted BPA improved recognition and referral for water safety counseling among high-risk pediatric ED patients. Ongoing data collection and iterative PDSA cycles will evaluate sustainability at our primary ED site and support spread across satellite sites.

Figure 1


Figure 2
Run chart showing outcome measure of % completed water safety consults in the main ED site

Figure 3
Run chart showing % of water safety consults placed across all ED sites