A Discharge Vital Sign Documentation Improvement Initiative in the Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Healthcare Data Analytics

Background:

• Vital signs are critical data in the pediatric emergency department (PED).
• Unexplained tachycardia at discharge is linked to increased patient return and admission.
• Current rates of complete discharge vital signs in the PED are suboptimal.

Purpose of the Study:

• To improve the rate of patients discharged with complete vital signs, when indicated, from 22% to 95% by June 30, 2018.
• To implement and sustain a quality improvement initiative in a pediatric emergency setting.
• To evaluate the impact of improved discharge vital signs on patient return rates and hospital admissions.

Main Methods:

• A multidisciplinary team utilized key driver analysis to identify improvement opportunities.
• Retrospective chart review was employed for data collection on discharge vital signs and 72-hour returns.
• Annotated p-charts were used to analyze trends in outcome and balancing measures, including PED length of stay (LOS) and hospital admissions.

Main Results:

• Discharge vital signs improved from a baseline of 22% to a sustained 85% over 7 months.
• The quality improvement initiative showed no significant change in 72-hour return PED visits or LOS.
• While absolute hospitalizations remained stable, the percentage of admitted patients slightly increased.

Conclusions:

• Targeted quality improvement methodology effectively sustains improved rates of indicated discharge vital signs in the PED.
• The observed improvement in vital signs documentation did not lead to adverse effects on return visits, LOS, or hospitalizations.
• This initiative demonstrates a successful strategy for enhancing critical data collection in pediatric emergency care.