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Action plans into action - An electronic action plan generation tool at a paediatric centre
Mark G Elliman1, Peter Sloman2, Mike South3
1Department of General Medicine, Royal Children's Hospital, Parkville, Australia.
Insights
Individualised Action Plans (APs) improve paediatric care. An electronic medical record (EMR) integrated AP tool showed good uptake and allowed for quality audits, guiding future improvements in AP content and user interface.
Area of Science:
- Pediatric Allergy and Immunology
- Health Informatics
- Clinical Quality Improvement
Background:
- Individualised Action Plans (APs) are crucial for managing paediatric conditions like asthma, allergy, anaphylaxis, and eczema.
- While APs are a quality marker, their content has been under-examined.
- The Royal Children's Hospital (RCH) implemented an Electronic Medical Record (EMR)-integrated AP generation tool in 2017.
Purpose of the Study:
- To evaluate the benefits of a hospital-wide integrated AP tool.
- To assess the uptake and usage of the AP tool at RCH.
- To identify quality and user interface issues through AP content audits.
Main Methods:
- A retrospective observational analysis of all APs generated in the RCH EMR for patients aged 0-18 years during 2018.
- Extraction and analysis of automatically populated and clinician-entered data fields from each AP.
Main Results:
- A total of 2637 APs were completed, with asthma plans being the most frequent.
- Omission rates of critical information were low but indicated room for improvement.
- Variations in AP completion location (Emergency Department vs. clinic) and clinician role (consultant vs. junior staff) were observed.
Conclusions:
- The EMR-integrated AP tool demonstrated considerable institutional uptake.
- Electronic APs facilitate qualitative usage evaluation and content auditing.
- Findings will inform further system and user interface enhancements to improve AP quality.
Background:
Individualised Action Plans (APs) are a key management tool for paediatric asthma, allergy, anaphylaxis and eczema. They provide salient care instructions for patients and caregivers and are thought to improve disease outcomes, albeit with minimal supporting evidence. Whilst the provision of an AP has become a widely measured healthcare quality marker, the content of the plans provided has been relatively neglected. The Royal Children's Hospital, Melbourne (RCH) implemented an AP generation tool integrated within its Electronic Medical Record (EMR) in 2017. This case study aims to exhibit the potential benefits of a hospital-wide integrated AP tool, assess its uptake and usage at our institution and demonstrate quality and user interface issues detected through audit of APs provided.
Methods:
A retrospective observational analysis of all APs created within the RCH EMR for patients aged 0-18 years between January 1 and December 31, 2018 was conducted. For each AP, automatically populated and clinician entered fields were extracted and analysed.
Results:
2637 APs were completed during the study period. The most used AP was for asthma. Omission rates of critical information were low but could be improved. Depending on clinical condition, there was variation in both the location of completion (ED vs clinic/hospital visit) and role of clinician completing the AP (consultant vs junior medical staff).
Conclusion:
There was considerable uptake of an EMR-integrated AP tool across our institution. An electronic AP allowed for qualitative evaluation of usage and audit of AP content and will guide further system and user interface improvements to improve AP quality.
