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Collaborative process improvement to enhance injury prevention in child death review
  1. Brian D Johnston1,
  2. Elizabeth Bennett2,
  3. Diane Pilkey3,
  4. Stephen J Wirtz4,
  5. Linda Quan2
  1. 1Harborview Medical Center, University of Washington, Seattle, USA
  2. 2Seattle Children's Hospital, Seattle, USA
  3. 3Washington State Department of Health, Olympia, USA
  4. 4California Department of Public Health, Sacramento, USA
  1. Correspondence to Dr Brian D Johnston, 325 Ninth Avenue – Box 359774, Seattle, WA 98104, USA; bdj{at}


Objective To increase the number and quality of injury prevention recommendations made by Washington State (USA) child death review teams.

Design Before and after study design involving four intervention teams and 21 comparison teams.

Methods Intervention teams received injury prevention training, collaborative process improvement coaching, and access to web based prevention resources. An equal number of randomly selected child death review case reports filed with the state before the intervention by the intervention and comparison teams were included in the baseline sample. All reports submitted by the intervention and comparison teams after the intervention were included in the follow-up sample. Reports were scored on the completeness of prevention related data elements and on the quality of written prevention recommendations.

Results Data completion for prevention relevant items increased in intervention teams from 73% at baseline to 88% at follow-up. In comparison teams, this measure fell from 77% to 56% over the same period. The quality of written recommendations produced by intervention teams increased from 4.3 (95% CI 3.4 to 5.1) to 7.6 (95% CI 6.7 to 8.5), while comparison teams showed no significant change (4.0 (95% CI 2.5 to 5.3) to 3.7 (95% CI 2.2 to 5.2)). Specifically, improvements were noted in the identification of evidence based best practices and the development of clear, actionable written recommendations.

Conclusion Injury prevention recommendations are generated in the systematic local review of child deaths. This process can be analysed, measured, supported, and improved.

  • Child
  • community
  • evaluation
  • government
  • public health

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  • Funding This work was supported, in part, by HRSA EMS-C Targeted Issue Grant H34MC02543-01-00.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Washington Human Subjects Review Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.