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Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement

QI 3: Subspecialty-specific QI & Patient Safety

699 - Improved Caloric Goal Documentation in the Pediatric Intensive Care Unit through Modification of Standardized Documentation

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 699
Publication Number: 699.153

Danica F. Vendiola, Medical College of Wisconsin, Wauwatosa, WI, United States; Amy Pan, Medical College of Wisconsin, Milwaukee, WI, United States; Jennifer Andres, Children's Wisconsin, Milwaukee, WI, United States; Nicole Fabus, Children's Hospital of Wisconsin, Lannon, WI, United States; Melissa M. Froh, Children's Hospital of Wisconsin, Wauwatosa, WI, United States; Rebecca Heisler, Children's Hospital of Wisconsin, Wauwatosa, WI, United States; Miranda R. Privatt, Medical College of Wisconsin, Milwaukee, WI, United States; Mary R C. Seidl, Medical College of Wisconsin, Wauwatosa, WI, United States; Martin K. Wakeham, Medical College of Wisconsin, Milwaukee, WI, United States; Theresa Mikhailov, Medical College of Wisconsin, Milwaukee, WI, United States

Presenting Author(s)

Danica F. Vendiola, B.S. (she/her/hers)

Medical Student
Medical College of Wisconsin
Wauwatosa, Wisconsin, United States

Background: Nutrition is an important aspect of care when treating critically ill children, with malnutrition prevalent among children admitted to the pediatric intensive care unit (PICU). Studies show worsened clinical outcomes for patients who suffer from malnutrition. Previous research states that early enteral nutrition within 48 hours of admission is associated with better health outcomes. Additionally, research shows that an early estimation and documentation of caloric goals in the electronic health record (EHR) is associated with higher daily energy intake. Establishing early caloric goals is often missing in medical charts due to various reasons, including the availability of a registered dietitian (RD). One approach to increase caloric goal documentation is to standardize the EHR with system prompts. By revising critical care progress notes to prompt providers to estimate a caloric goal when no caloric goal has already been documented by a RD within the first 48 hours, we expect an increased rate of goal documentation.

Objective: Increase documentation of a caloric goal within 48 hours of PICU admission for all children by 20%.

Design/Methods: The Plan-Do-Study-Act (PDSA) quality improvement method was used. We obtained de-identified data from the Children’s Wisconsin PICU through the local Virtual Pediatric Systems, LLC database (VPS). Between May 2020 and April 2021, we obtained baseline data of the frequency of estimated caloric goal documentation within the first 48 hours of PICU admission. A smart link prompt was developed and incorporated into the EHR progress notes templates in May 2021 (see Figures 1 and 2). We monitored the monthly rate of documentation of caloric goals within 48 hours of admission by critical care providers up to April 2022. To analyze and monitor the results, we used a statistical control (p-chart).

Results: The baseline rate of documentation of an estimated caloric goal within 48 hours of admission was 44% (May 2020-April 2021). Upon adding standardized prompts to the EHR system, the rate of documented caloric goal intake within 48 hours of admission by critical care providers was greater than 90% (see Figure 3).

Conclusion(s): Utilizing automated systems-based prompting in EHRs resulted in an increased frequency of caloric goal documentation exceeding 90% monthly. Establishing a standardized prompting system within the EHR directly led to an overall increased frequency of caloric goal documentation. Future steps are to analyze if the increased documentation led to a direct increase in initiation of enteral nutrition and caloric intake as well as improved health outcomes.