Optimising drowning prevention counselling through a physician Maintenance of Certification (MOC) quality improvement (QI) initiative

Drowning is the leading cause of death in children 1-4 years old in the USA. Paediatricians play an important role in giving anticipatory guidance on drowning prevention. This quality improvement initiative aimed to increase the rate of drowning prevention counselling with provision of educational materials to caregivers of children aged 0-10 years during clinical encounters in an outpatient setting.We refined a previously published Texas state educational programme that included evidence-based counselling strategies across three Plan Do Study Act (PDSA) cycles, with the addition of preintervention baseline counselling phase during expansion of the programme nationally to 17 and 21 states in 2022 and 2023, respectively. All participating paediatricians in office-based, urgent care and emergency settings completed demographic, preintervention and postintervention and programme evaluation surveys. Paediatricians in office-based settings (majority of participants) tracked counselling rate across baseline and three PDSA cycles. Caregivers completed postintervention surveys on knowledge and anticipated behaviour change. Drowning prevention education was supplemented by materials provided to caregivers including brochures and wearable water watcher tags to promote adult supervision.During the first 2 years of national expansion, 120 physicians and 7886 caregivers participated in the programme. Provision of drowning prevention educational materials to caregivers significantly closed an existing gap. Less than 25% of caregivers reported receipt of brochure/checklist and only 6% water watcher tag at baseline; compared with 98% and over 90%, respectively, after PDSA 3 in both years. 69.3% of physicians were able to efficiently counsel on drowning prevention within 2 mins in 2022 versus 82.1% in 2023 (p value<0.001). Most caregivers found the counselling helpful and planned to use the water safety strategies. We demonstrated a significant increase in mean counselling rate from preintervention phase (26.8%) through end of PDSA 3 (64.9%) in this national programme.