Integrating Population Health Data on Violence Into the Emergency Department: A Feasibility and Implementation Study

Abstract

Geocoded emergency department (ED) data have allowed for the development and evaluation of novel interventions for the prevention of violence in cities outside of the United States. First implemented in Cardiff, United Kingdom, collection of these data provides public health agencies, community organizations, and law enforcement with place-based information on assaults. The purpose of this study was to assess the feasibility of translating this model within the electronic medical record (EMR) in the United States. A new EMR module based on the Cardiff Model was developed and integrated into the existing ED EMR. Data were collected for all patients reporting an assaultive injury upon arrival to the ED. Emergency department nurses were subsequently recruited to participate in 2 surveys and a focus group to evaluate the implementation and to provide qualitative feedback to enhance integration. Nurses completed EMR questions in 98.2% of patients reporting to the ED over the study period. More than 90% of survey respondents were satisfied with their participation, and most felt that the questions were useful for clinical care (79/70%), were integrated well into workflow (89/90%), and were congruent with the ED and hospital goals and mission (93/98%). Focus group themes centered on ED culture, external factors, and internal workflow. It is feasible to implement place-based, assault-related injury-specific questions into the EMR with minimal disruption of workflow and triage times. Nurses, as key members of the ED team, are receptive to participating in the collection of population health data that may inform community violence prevention activities.

Building capacity for injury prevention: a process evaluation of a replication of the Cardiff Violence Prevention Programme in the Southeastern USA

“…Other ongoing challenges include continuing financial support for a VPC, maintaining high nursing participation in screening and expanding the CMST to more comprehensively include all critical care and trauma patients. Nurse participation in the satisfaction survey may be considered low (51%), although this is a similar past response rate when the survey was implemented in a different US hospital 22. The hospital’s primary role is to provide care, thus, medical care needs must first be met and then CMST data collection may occur among critical care and trauma patients.…”

“…Minor US adaptations include word choices (eg, bar vs pub) and item ordering. Other US-based Cardiff Model projects may want to consider collecting information on unintentional injuries to inform public health prevention strategies (see the Wisconsin adaptation) 22…”

“…An adapted 26-item nurse satisfaction survey22 was administered using paper and pencil from 6 July 2016 through 1 September 2016. For this process evaluation, six items (1: desire to see Cardiff Model reports, 2: satisfaction with the Cardiff Model, 3: commitment to the Cardiff Model, 4: Cardiff Model supportive of hospital goals and mission, 5: Cardiff Model integrated into the nurse workflow and 6: nurses are able to collect Cardiff Model data from patients), measured on 6-point scales (very dissatisfied to very satisfied and strongly disagree to strongly agree), were used.…”

“…For every $1 spent on the model, nearly $15 in health system and over $19 in criminal justice system costs are saved (Cardiff Model cost savings are reported by Florence et al 14 as ratios; numbers reported were converted to US dollars) 14. While several published articles provide evidence of the effectiveness and cost-benefit of the Cardiff Model9 14–19; and of the benefits of cross-sectoral relationships,20 one process evaluation describes model integration into a UK ED,21 one describes the feasibility and implementation of Cardiff Model integration into a paediatric ED,22 and none document the collaborative ED and LE agency process in the USA. Therefore, this process evaluation is the first to document the US Cardiff Model adaptation, implementation and collaboration between a large, urban ED with a level I trauma designation and a local county LE agency in the Atlanta, Georgia metropolitan (Cardiff Model implementation also has taken place in Philadelphia, Pennsylvania, USA and Milwaukee metropolitan area, Wisconsin, USA.…”

Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department

“…Prior pilot studies from around the globe demonstrated Cardiff Model feasibility and adequate patient information collection about assaultive injuries in the healthcare setting. [11][12][13][14] Information collected includes time and location of the assault, and weapon(s) used. This information is then deidentified, aggregated and analysed in tandem with law enforcement data.…”