Objectives Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children < 12 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months. Methods We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan‐do‐study‐act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children < 1 year old with high‐risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS). Results Evidence of special cause was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8‐month period, the CPT was consulted for a mean of 47.5% of children with high‐risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high‐risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%. Conclusion Targeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high‐risk injuries. Such interventions may improve recognition of physical abuse.

BACKGROUND AND OBJECTIVES: Throughout the COVID-19 pandemic, there has been an increase in hospital admissions for adolescents with eating disorders (EDs). However, there is a paucity of information on how this increase has affected hospitalization courses and disposition planning. We sought to describe the changes in hospitalizations for EDs at our institution during the pandemic. METHODS: We reviewed charts of patients admitted to our academic medical center for nutritional restoration from January 1, 2017, to June 30, 2021. We report differences in patient characteristics and hospitalization courses using descriptive statistics and Poisson regression. RESULTS: We reviewed charts for 85 patients for 108 hospital admissions. Admissions increased from 1.4 per month prepandemic to 3.6 per month during the pandemic (P &lt; .001). Most patients were female (91%), White (79%), had private insurance, (80%) and had restrictive eating behaviors (97%). During the pandemic, we found (1) an increase in the average length of stay (12.6 days vs. 18.0 days) with younger age associated with longer length of stay (P &lt; .001); (2) more patients requiring psychotropic medication management (11% vs 31%, P = .01); and (3) fewer patients discharged from the hospital with outpatient therapy (43% vs 24%, P = .03). CONCLUSIONS: In addition to an increase in hospital admissions for ED management during the pandemic, our study highlights the evolving needs of ED patients during their hospitalizations. The implications of longer admissions with higher acuity at discharge represent areas where appropriate adaptations in inpatient management and disposition planning may improve the quality of care for ED patients.

PurposeThe purpose of this study is to report a case of Providencia stuartii conjunctivitis.MethodsThis study is a retrospective chart review of a patient with persistent conjunctivitis.ResultsWe report the first case of P. stuartii conjunctivitis. Our patient was an elderly man living in a nursing home who was likely immunocompromised from longstanding diabetes mellitus. A conjunctival swab culture was able to identify the infecting bacteria and its antibiotic susceptibility. The conjunctivitis was successfully treated with vancomycin drops and oral sulfamethoxazole and trimethoprim.DiscussionP. stuartii is an increasingly common bacterium found in the urine of immunocompromised nursing home residents with indwelling Foley catheters. While it has rarely been found to cause ocular infections, P. stuartii may be suspected in elderly, immunocompromised nursing home residents.

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