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Improving asthma documentation in a paediatric emergency department
S Teo1, R Hanson, P Van Asperen
1Children's Hospital, Camperdown, New South Wales, Australia.
Insights
Total quality management (TQM) improved some aspects of acute asthma documentation in the Emergency Department (ED). Further research is needed to determine if better documentation leads to improved patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Clinical Documentation
Background:
- Poor documentation of acute asthma in children presenting to the Emergency Department (ED) can impact care.
- A need exists to enhance the quality and consistency of medical records for pediatric asthma patients.
Purpose of the Study:
- To improve the documentation process for children with acute asthma in the ED.
- To identify and address deficiencies in medical and nursing documentation.
Main Methods:
- A Total Quality Management (TQM) approach was used to analyze documentation.
- Phase I involved record review and establishing minimum documentation criteria.
- Phase II introduced a proforma to assess improvements in documentation rates.
Main Results:
- Initial documentation compliance varied significantly for both nurses and doctors.
- Phase I showed low rates for documenting asthma severity and follow-up.
- Phase II demonstrated statistically significant improvements in several key documentation areas post-intervention.
Conclusions:
- The TQM process was effective in enhancing certain aspects of pediatric asthma documentation.
- The long-term impact of improved documentation on patient outcomes requires further investigation.
Objective:
To improve documentation for children presenting to the Emergency Department (ED) of The Children's Hospital with acute asthma.
Methodology:
In phase I, the documentation process was analysed using a standard total quality management (TQM) approach to identify specific problems leading to poor documentation. Fifty-two medical records of children presenting over a 3 week period were reviewed for nursing and medical documentation. A set of minimum criteria, consistent with the Paediatric Asthma Management Plan, were established for documentation by both medical and nursing staff. Following dissemination and education, compliance with documentation was evaluated and compared to an asthma survey performed in the ED in 1991. In phase II, a specific proforma for medical assessment was developed and 80 medical records of children presenting over a 3 week period were reviewed. Fifty-two (65%) with completed proformas were evaluated. The outcome measure was the documentation rate for minimum criteria established by TQM process.
Results:
In phase I, nursing compliance with documentation ranged from 46% for signs of respiratory distress to 83% for a past history of asthma and 100% for pulse rate. Doctors were similarly poor at documenting essential elements such as severity (31%), palpable pulsus paradoxus (29%), the child's usual doctor (46%) and follow-up arrangements (21-56%). In phase II, the documentation of the severity of acute asthma (42%) and of the child's usual doctor (42%) remained poor but there were statistically significant improvements in documentation of interval medications, palpable pulsus paradoxus, respiratory rate, pre-treatment oximetry, education, follow-up arrangements and communication letters.
Conclusion:
The process of TQM has proved valuable in improving some aspects of documentation of children presenting to ED with acute asthma. It remains to be shown whether improved documentation will result in improved outcome.