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Perceived frequency and impact of missing information at pediatric emergency and general ambulatory encounters
Lisa M Schilling1, Lori A Crane, Allison Kempe
1University of Colorado Denver School of Medicine, Department of Medicine.
Insights
Missing clinical information is more frequent in pediatric ambulatory care than emergency visits. This impacts care quality, efficiency, and patient satisfaction, necessitating better information access.
Area of Science:
- Pediatric Medicine
- Health Informatics
- Quality Improvement
Background:
- Unavailable clinical information poses challenges in healthcare settings.
- Understanding the impact of missing data is crucial for improving patient care.
Purpose of the Study:
- To document the frequency, type, and impact of missing clinical information during pediatric emergency and general ambulatory encounters.
- To assess physician perceptions of how missing data affects care quality and resource utilization.
Main Methods:
- Prospective cohort study at a children's hospital's Emergency Department and General Ambulatory Pediatric Clinic.
- Pediatric attending physicians reported on missing information, its location, time spent seeking it, and perceived effects.
- Outcome measures included frequency, impact on efficiency, confidence, satisfaction, and resource use.
Main Results:
- Physicians reported missing information in 2% of emergency and 22% of general ambulatory encounters.
- Missing information, particularly at ambulatory visits, often related to immunizations and past medical history.
- Adverse effects included reduced efficiency (64%), physician confidence (33%), patient satisfaction (17%), and increased likelihood of additional tests (38% treatment, 16% labs, 12% imaging).
Conclusions:
- Missing clinical information is more prevalent in pediatric general ambulatory settings compared to emergency departments.
- The study highlights significant negative impacts on care quality, efficiency, physician confidence, patient satisfaction, and resource utilization due to missing data.
Objective:
To document the perceived frequency, type, and impact of unavailable ("missing") clinical information during pediatric emergency and general ambulatory encounters.
Methods:
This prospective cohort set in the Emergency Department and General Ambulatory Pediatric Clinic at The Children's Hospital, Aurora, CO, assessed pediatric attending physician perceptions regarding missing information at emergency and general ambulatory encounters. The main outcome measures were the frequency of perceived missing information; its presumed location; time spent seeking; and the perceived effects on resource utilization and overall quality of care.
Results:
Pediatric physicians reported missing information for 2% of emergency and 22% of general ambulatory encounters. Types of missing information at general ambulatory visits included immunization (34% of types), general past medical (29%), and disease or visit specific histories (13%). Missing information at ambulatory visits was sought 20% of the time, obtained 4% of the time, and rated "somewhat or very important for today's care" (73% of the time) and "somewhat or very important for future care" (84% of the time). For encounters with unattained missing information, physicians reported adverse affects on the efficiency of the visit (64%), physician's confidence in care (33%), patient/family satisfaction (17%), disposition decisions (8%), and recommended additional treatment (38%), laboratory studies (16%), and imaging (12%). For 57% of encounters with missing information, physicians perceived an adverse effect on overall quality of care. Missing information was associated with not having a primary care visit at TCH within 12 months of the encounter, (OR 2.8; 95% CI, 1.7, 4.5).
Conclusion:
Pediatric physicians more commonly experience missing information at general ambulatory visits than emergency visits and report that missing information adversely impacts quality, efficiency, their confidence in care, patient and family satisfaction, and leads to potentially redundant resource utilization.
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