Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data
Ashimiyu B Durojaiye1,2, Scott Levin3, Matthew Toerper3,4
1Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Collaborative electronic health record (EHR) usage patterns in pediatric trauma care were identified. Greater collaboration, indicated by a fully connected EHR usage pattern, was linked to shorter emergency department lengths of stay.
Area of Science:
- Health Informatics
- Medical Informatics
- Trauma Care Research
Background:
- Electronic Health Records (EHRs) are crucial in modern healthcare, but understanding collaborative usage patterns remains a challenge.
- Optimizing care for pediatric trauma patients requires insights into team communication and workflow efficiency within EHR systems.
Purpose of the Study:
- To identify distinct collaborative electronic health record (EHR) usage patterns among pediatric trauma patients.
- To determine the relationship between identified EHR usage patterns and patient outcomes, specifically emergency department length of stay (ED LOS).
Main Methods:
- Process mining and network analysis were applied to EHR metadata and trauma registry data.
- Event logs were segmented, and usage patterns were constructed by analyzing functional role interactions within temporal segments.
- Graph kernel and spectral clustering methods were used to classify usage patterns, followed by comparative analysis of patient demographics, clinical data, and ED LOS.
Main Results:
- Three distinct EHR usage patterns were identified: fully connected (clique), partially connected, and disconnected (isolated).
- The fully connected pattern was associated with a significantly shorter median ED LOS compared to the partially connected pattern.
- Partially connected patterns were more common during day shifts and involved specific services like otolaryngology and ophthalmology.
Conclusions:
- A higher degree of multidisciplinary collaboration, represented by a clique-like EHR usage pattern, is associated with reduced ED LOS in pediatric trauma patients.
- Further research is needed to understand the causal factors influencing these collaborative patterns to improve patient care pathways.
Objectives:
The study sought to identify collaborative electronic health record (EHR) usage patterns for pediatric trauma patients and determine how the usage patterns are related to patient outcomes.
Materials And Methods:
A process mining-based network analysis was applied to EHR metadata and trauma registry data for a cohort of pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The EHR metadata were processed into an event log that was segmented based on gaps in the temporal continuity of events. A usage pattern was constructed for each encounter by creating edges among functional roles that were captured within the same event log segment. These patterns were classified into groups using graph kernel and unsupervised spectral clustering methods. Demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS) of the groups were compared.
Results:
Three distinct usage patterns that differed by network density were discovered: fully connected (clique), partially connected, and disconnected (isolated). Compared with the fully connected pattern, encounters with the partially connected pattern had an adjusted median ED LOS that was significantly longer (242.6 [95% confidence interval, 236.9-246.0] minutes vs 295.2 [95% confidence, 289.2-297.8] minutes), more frequently seen among day shift and weekday arrivals, and involved otolaryngology, ophthalmology services, and child life specialists.
Discussion:
The clique-like usage pattern was associated with decreased ED LOS for the study cohort, suggesting greater degree of collaboration resulted in shorter stay.
Conclusions:
Further investigation to understand and address causal factors can lead to improvement in multidisciplinary collaboration.
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