A Quality Improvement Initiative to Screen for Bullying in Pediatric Orthopedic Outpatient Clinics.

Abstract

Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5-18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners. The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health. Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.