Pilot intervention to improve the documentation of pediatric injuries in the emergency department

Abstract

Objectives: Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries. Methods: All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injuryspecific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Postintervention documentation was compared to pre-intervention documentation for the 14 predefined data elements. Results: Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting "the presence of an adult observer" to 0.09 (95%CI, 0.01 to 0.76) for charting "sports equipment related to the injury." The "flagging" of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention. Conclusion: A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.

Strategies for improving physician documentation in the emergency department: a systematic review

“…printed education materials) in effecting lasting changes in physicians’ documentation behavior [15, 58–61]. While the findings from our review tend to confirm that active interventions such as audit/feedback, reminders, or templates and/or multiple interventions may improve physician documentation, we did observe mixed results with respect to documentation comprehensiveness and accuracy when these interventions were introduced into ED settings [26, 44, 47, 48, 50, 51, 54, 55]. The quality of the studies identified in this review, and variability in settings, outcome measures, and intervention duration across studies may have contributed to this finding; when appropriately designed for the context or environment in which they will operate, these interventions may prove even more effective in supporting improvements in physician documentation.…”

“…Four studies (one pre-post without control, one pre-post control, two prospective follow up with comparison) assessed the impact of multi-interventions on the quality of physician documentation [52–55]. While all studies included an education component, they varied in the type and number of other interventions that were included.…”

“…In contrast, Teo et al (1995) found that, while the introduction of templates did improve physician documentation of required items for asthma diagnosis and reporting in a pediatric emergency department, education and reminders did not result in any significant increase in the presence and completeness of asthma documentation [54]. Finally, Voaklander et al (2000) reported that pocket cards and chart labels significantly increased the number of items recorded for pediatric injuries, including activity at the time of injury, yet decreased documentation of injury prevention measures [55].…”

Unspecified falls among youth: predictors of coding specificity in the emergency department

“…Without specific prompting using standardized template charts, it seems unreasonable to expect front line staff to report a set of mandatory injury specific variables. Previous research from this region showed a modest increase in charting pediatric injury information with education 16 ; however, this increase may have been short lived. Finally, the use of known preventive injury strategies is also not collected routinely or in a standardized fashion.…”