Bruise to decision times in Non-Accidental Injury

Objective:Children referred to hospital for further investigations in non accidental injury often face an uncertain length of stay. Anecdotally we felt in our local unit the time period for investigations was having a... [ view full abstract ]

Objective:

Children referred to hospital for further investigations in non accidental injury often face an uncertain length of stay. Anecdotally we felt in our local unit the time period for investigations was having a detrimental effect on parent-child interaction. Whilst recognising the importance of thorough investigations we reviewed the timescale it took for child protection procedures in a large sized district general hospital in Wales.

Method:

Retrospective audit of all referrals made under unexplained bruise in non mobile infant policy in a single calendar year (2015). A database was created for further analysis.

Results

A total of 65 referrals were received. 61 of these cases were further analysed and four were omitted due to lack of access to clinical records. 96% children were seen by a senior doctor within 12 hours of admission. 26 children warranted further investigations.  31% and 32% of these referrals had CT scan and skeletal survey respectively. 21% had CT scan after 48 hours of admission. 30% had skeletal survey after 48 hours of admission. 32% referral had a multidisciplinary strategy meeting. 80% of cases had strategy meeting after 48 hours of admission. 59% referrals were discharged on the same day of admission. 31% of referrals stayed in hospital for more than 48 hours. Among them, 11% (n=7) stayed more than 5 days.

Conclusion

Main reasons for delayed discharge were delayed radiological investigations and strategy meetings. Evidence suggests prolonged duration of hospital stay has unfavourable impact on parents and children .This also poses pressure on acute hospital beds. Multidisciplinary working and innovative approaches are required to provide an effective service and minimise need for hospital stay. We have researched how these services can be improved and would like to share our model of change.