Table 1.
Triggers embedded into the EHR at UPMC Hamot and UPMC Mercy
| Form name/who completes the form | Name and value of field which results in a trigger when combined with patient age | Age requirement for triggering | Criteria which prevents activation of the child abuse alert system | First trigger |
|---|---|---|---|---|
| Child abuse screening form/RN | “Are any of the following findings present on physical examination? In a non-mobile child – ANY bruise, burn, subconjunctival hemorrhage, or frenulum injury. In a mobile child – Bruises, burns or other markings in the shape of an object; or Bruises on non-bony prominences/protected regions (eg, torso, genitalia/buttocks, upper arms, ear, neck); or More bruises than you would expect to see in even an active child.” with “yes” response (Q3) | <2 y | NA | 16 (10) |
| Child abuse screening form/RN | “Are you concerned that the history may not be consistent with the injury or illness” with a “yes” response (Q2) | <2 y | NA | 13 (8) |
| ED Assessment Form v2: Focused assessment of complaint; Chief complaint/RN | Any of the following words in a CC or focused assessment for a child <12 months of age: assault, abuse, bruis, burn, not moving, fracture, fx, broke, injury, sprain, deformity, subconjunctival hemorrhage, petechiae, arrest, hematom, ecc, echy, OR contus | <1 y (<6 mo for “injury”) | Do not trigger if trigger word is preceded by denie, no, or not; if Burn is preceded by Dr; if cord precedes fall or fell; if broke is followed by out, English, or or; if fever precedes broke | 54 (35) |
| ED Assessment Form v2: Chief complaint; focused assessment/RN | Any of the following words in a child <6 months of age: “fall,” “fell” | <6 mo | Do not trigger if Fall or Fell is followed by asleep do not trigger on fallot | 28 (18) |
| Orders/MD | Order for bone survey infant x-ray, bone survey limited x-ray or bone survey x-ray | <2 y | NA | 14 (9) |
| Orders/MD | Order for x-ray of clavicle, foot, finger, hand, knee, femur, tibia, fibula, wrist, ankle, skull, elbow, humerus, shoulder, skeletal, or extremity | <1 y | NA | 7 (4) |
| Discharge/MD | DC instruction title of abuse, fracture, injury, injuries, burn, cast, contusion, clavicle, dislocation, subluxation, hematoma, hyphema, nursemaid, hemorrhage, or bruise | <1 y | Do not trigger is if inj is preceded by head | 13 (8) |
| Discharge/MD | DC diagnosis of “contus” | <1 y | 8 (5) | |
| Discharge/MD | DC instruction of child abuse, abuse and neglect, jaw fracture, nose fracture, sternum fracture, or rib fracture | <2 y | NA | 1 (1) |
| Discharge/MD | Follow up in depart with clinic or office that has ortho, plastic, burn trauma (to pick up Burn Trauma Center-UPMC Mercy; Children's Hospital Orthopedic Clinic; CHP Orthopedics; CHP Plastics Department; Hamot Orthopedic Clinic; Hamot Orthopedic Hand; Hamot Orthopedics) | <1 y | NA | 2 (1) |
Values are n (%).
CA-CDSS: child abuse clinical decision support system; CHP: Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center; DC: discharge; ED: emergency department; EHR: electronic health record; MD: medical doctor; NA: not applicable; RN: registered nurse; UPMC: University of Pittsburgh Medical Center.