Improving Documentation Using a Real-Time Location System in a Pediatric Emergency Department.

Area of Science:

• Healthcare Quality Improvement
• Medical Informatics
• Pediatric Emergency Medicine

Background:

• Accurate documentation of critical care services, including time-based parameters, is essential for severity of illness metrics and reimbursement.
• Inconsistent documentation of time-based elements for critical care services in emergency departments (ED) poses a challenge.
• Electronic medical record and real-time location system (RTLS) data integration was used to enhance quality improvement.

Purpose of the Study:

• To increase appropriate documentation of critical care services in a pediatric ED from 76% to 90% within six weeks.
• To improve the accuracy of severity of illness metrics and ensure proper reimbursement through enhanced documentation.
• To address inconsistencies in documenting time-based elements for critical care services.

Main Methods:

• Utilized a framework of improvement and plan-do-study-act cycles focused on key drivers.
• Integrated RTLS for precise location tracking to identify critical care encounters and minimize audits.
• Developed and iteratively revised interventions to address key drivers and improve documentation.

Main Results:

• Analyzed 92 encounters between March and April 2020.
• The proportion of eligible patient encounters with critical care documentation improved from 76% to 85%.
• Patients with respiratory complaints represented the majority of encounters lacking appropriate documentation.

Conclusions:

• RTLS integration with improvement methodology successfully identified physician-patient co-location for critical care services.
• Interventions were designed to enhance documentation of critical care services in a pediatric ED.
• RTLS demonstrates utility in augmenting and informing systematic improvement efforts, despite changes not being directly attributable to this project.