Childhood Poverty in the Emergency Room: Using Quality Improvement (QI) for Better Identification and Support of Poor Families in Clinical Practice

Introduction: Poverty is the most important determinant of child health in the UK, associated with adverse health, developmental, educational and long-term social outcomes. The Emergency Room (ER) is increasingly the site where poverty in families is encountered - and yet clinicians often feel powerless, with training gaps and underdeveloped pathways leading to missed opportunities to help poor families. We used QI methodology in the ER to develop clinical surveillance tools and advice for addressing poverty in practice.

Methods: Stakeholders in the ER co-designed tailored surveillance questions to be used with established poverty risk factors including single parent, unemployment, >3 children, chronic health conditions and social worker involvement. Teaching was delivered to the team and our bespoke, local child poverty leaflet (with resources that increase income, provide essentials and increase participation) was offered when appropriate.

Results: At baseline, no doctors or nurses in the ER asked about child poverty or signposted to relevant local resources. Teaching sessions were delivered and plan-do-study-act (PDSA) cycles tested questions and resource leaflets while improving stakeholder buy-in. Identification of child poverty increased from 0% to 89% in just 8 weeks, with resource awareness increasing from 0% to 100% in the same period. Qualitative patient feedback has been positive: e.g. “Thank you, this is useful, you really helped me”.

Conclusions: While busy ER clinicians juggle many responsibilities, they can play a vital role in helping families living in poverty. This project demonstrates a) how QI can be used to translate public health evidence into changes in clinical practice to better identify and address child poverty, and; b) how ERs can be used to opportunistically deliver health promotion. Going forward, we aim to use more PDSA cycles to further enhance stakeholder participation in poverty surveillance, and patient co-design to refine the resources offered.