Emergency Medicine: Quality Improvement
Emergency Medicine 10
Jessica Katznelson, MD (she/her/hers)
Assistant Professor of Pediatrics and Emergency Medicine
Johns Hopkins School of Medicine
Baltimore, Maryland, United States
Nearly half of all children seeking emergency department (ED) care are seen in low volume EDs. Evaluating the quality of pediatric care in these settings can be difficult. Little on the subject exists in the literature. Recently the National Pediatric Readiness Quality Initiative (NPRQI) published a consensus driven set of quality metrics, created through a modified Delphi process, for use in low volume ED.
Critical Access Hospital (CAH) have low volume EDs that serve as the safety net for pediatric emergency care in their rural catchment areas. Concerns have been raised about adult care metrics in these ED, but little is known about the quality of pediatric care. Such data is necessary in order to undertake effective performance improvement efforts.
To assess how well a cohort of CAH ED is performing on a subset of the NPRQI quality measures.
Using an already existing database containing information on all patients < 18 years seen in 3 CAH ED in a single state over a 2 year period, we assessed compliance with a set of the NPRQI quality metrics. These included 1) % of patients documented with weight only in kg, 2) % of patients with a pain score assessed, 3) % of patients with vital signs reassessed, 4) % of patients with asthma or croup that received a steroid, 5) % of patients > 2 years with asthma who received a beta agonist, 6) % with asthma or bronchiolitis that had a chest x-ray, 7) % of vomiting patients that received an antiemetic and 8) % of vomiting patients that received oral rehydration.
A total of 10563 visits were reviewed. While 95% of patients were weighed in kg, 59% were also weighed in pounds. 42% of patients had a pain score assessed and 33% had vital signs reassessed. Only 32% of the 295 patients with asthma or croup visit diagnoses were given steroids. 52% of patients with asthma visit diagnosis and 48% of those with bronchiolitis had a chest xray. 541 patients had vomiting as a chief complaint, 61% were given an antiemetic, and 85% received oral rehydration.
The CAH ED in our sample performed unevenly on the set of metrics reviewed. Less than half of patients were weighed in kg alone. Limited numbers had pain scores documented or vital signs reassessed. While a large percentage of vomiting children received oral rehydration, a significant percentage of the respiratory patients received x-rays. The NPRQI metrics reviewed suggest there may be a need for significant pediatric performance improvement projects across the CAH ED setting. Future study is needed to assess the impact of improvement projects.