Background Accidental injuries in non-mobile babies are very uncommon, therefore even minor injuries could indicate serious abuse and require appropriate investigation.

In our ED in a large tertiary children’s hospital in the UK, any non-mobile baby presenting with a visible injury is considered at risk of abuse and therefore follows a standardised pathway. This involves a multi-agency approach in which checks are conducted with social care and the police to ensure the clinician can make an informed decision about the safety of the child. However, audits in 2016 and 2017 demonstrated that compliance to the pathway was poor (68.6%) with only half of clinicians completing a background check (54.3%) or passing on these results to the GP (51.4%).

Objectives Our aim was to identify obstacles to the non mobile baby pathway and address them in order to streamline the process for clinicians, social care and families.

Methods A multidisciplinary task group was set up including members from clinical and administration teams. With the assistance of our QI department, we completed process mapping, fishbone analysis and a prioritisation matrix. A questionnaire was then distributed amongst clinicians in order to identify specific obstacles to the pathway, and the results analysed.

Results The questionnaire was completed over two weeks in November 2020 by 27 of the medical and nurse practitioner team ranging in experience from 3 months to over 10 years.

Results identified that although all clinicians were aware of the process and 93% were able to identify patients who needed to undergo it, only 78% were confident in actually undertaking the process.

The time taken to complete the process ranged from 10 to 120 minutes amongst participants and of those who provided numerical responses, over half stated it took over 60 minutes.

Half (48%) of respondents found it difficult to locate the phone number to call when undertaking the checks.

When asked for areas of improvement within the process, participants most commonly identified; the need for a clear guideline, easy access to phone numbers, leaflets for parents and further training for clinicians and social care.

Conclusions We believe that our process for managing injuries in non-mobile babies is fairly unique and has already improved identification of children at risk of significant harm. The feedback gained and subsequent analysis has enabled us to recognise and address specific obstacles which can be targeted for improvement, to ensure a more streamlined process that it is both time efficient and as safe as possible.

A simplified guideline and patient information leaflet has been created and approved, along with a poster for our waiting room to explain the procedure to families. We also continue to improve awareness and understanding of the procedure amongst our colleagues through education. In the near future, we also hope to integrate the procedure within our IT infrastructure to allow a more efficient pathway.

We believe that our changes enable significant improvement of the non-mobile baby pathway for both clinicians and families, in what can be a challenging and stressful process.