Implementation of an EHR-Based Emergency Information Form for Children With Medical Complexity

Area of Science:

• Pediatric Emergency Medicine
• Health Informatics
• Clinical Decision Support

Background:

• Children with medical complexity (CMC) require specialized care, and timely access to accurate clinical information is crucial for effective emergency department (ED) management.
• Existing information systems may not adequately support the complex needs of CMC during ED visits.

Purpose of the Study:

• To design and implement an electronic health record (EHR)-based Emergency Information Form (EIF) to improve the ED care of CMC.
• To assess the feasibility, utilization, and impact of EIFs on ED care processes and outcomes for CMC.

Main Methods:

• A Model for Improvement framework was used to engage stakeholders in developing and implementing EIFs within the EHR.
• EIFs included comprehensive patient summaries, prehospital triage, resuscitation status, and care plans.
• An EHR-based alert system was implemented to notify providers of EIF availability. Outcomes measured included time to disposition, EIF accuracy, care expedience, and hospitalization rates.

Main Results:

• EIFs were created for 311 CMC, supporting 838 ED visits over a 2-year period.
• 98% of ED providers found EIFs to contain accurate information, and 86% believed they expedited care.
• A clinician-led initiative increased EIF utilization from 42% to 64%. No significant change in time to ED disposition was observed, but a modest reduction in hospitalization rates (53.4% to 50.5%) occurred.

Conclusions:

• The study demonstrates the feasibility and utilization of EHR-based EIFs for providing timely and accurate clinical information to support the ED care of CMC.
• While EIFs enhance information accessibility and perceived care expedience, they did not demonstrably influence ED disposition efficiency.
• Further research may explore optimizing EIF integration to impact ED workflow and patient disposition times.