Acute child sexual assault exams: a quality improvement project Public Deposited

Child sexual assaults number about 115,000 annually. The American Academy of Pediatrics and a panel of child maltreatment medical experts known as the “Adams” group maintain updated guidelines for examination, diagnosis, and treatment of child sexual assault victims. Chart reviews at the project site demonstrate that child sexual assault (CSA) exams in the emergency department (ED) do not adhere to current national and state CSA guidelines for anogenital exam documentation, taking anogenital photo-documentation, and photo-documentation quality. A plan-do-study-act model was used to assess current practice, plan strategies to improve adherence to CSA guidelines, and for ongoing improvement. Chart review of all CSA ED patients were performed to measure guideline adherence and compare data before and after the intervention. An educational module for ED nursing and provider staff was created based on current CSA guidelines and presented to ED CSA champions and provider representatives in didactic sessions. One-on-one coaching was available following the didactic education. Descriptive statistics were collected, and inferential statistics were performed on collected data. Independent t-tests demonstrated that exam adherence to CSA guidelines was higher in post-education exams than pre-education exams for forensic collection, photo quality, and anogenital exam documentation, but was not statistically significant due to small sample sizes. However, some clinical significance was exhibited by the increase in CSA guideline adherence following the educational intervention. Recommendations for continued adherence to CSA guidelines are ongoing CSA staff education, development of electronic documentation and flowsheets for CSA exams, and continuation of chart reviews to evaluate guideline adherence.

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