1. Adam A Vukovic, MD, MEd1, 2; Corrie Berry, RN, MMHC, BSN, CPEN2
Implementing Discharge Vital Signs in the Pediatric Emergency Department
Adam A Vukovic, MD, MEd1, 2; Corrie Berry, RN, MMHC, BSN, CPEN2
1. Department of Pediatrics; 2. Pediatric Emergency Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt
Background
Results
Results, continued
Figure 1. Key Driver Diagram
Data were collected for 16 months
14,872 patients included
3,909 out of 7010 (56%) patients had discharge vital signs performed when indicated
Manual discharge vital sign order entry improved discharge vital signs from 21.4% to 40.8%
Targeted QI methodology further improved discharge vital signs from 40.8% to 84.6%
There were no differences in 72 hr return visits or total length of stay for patients discharged on index visit (not shown)
Vital sign abnormalities are an important data point for patients in the pediatric emergency department (PED)
Tachycardia has been associated with representation and readmission
Tools such as the emergency severity index (ESI) have been developed to aid in triaging and identifying ill patients
These tools drive vital sign reassessment
Nature of the PED hinders vital sign reassessment and impedes situational awareness
Objectives
Conclusions
To use quality improvement (QI) methodology to improve the percent of patients discharged from the pediatric emergency department (PED) with a complete set of vital signs, when indicated, from a baseline of 20% to 95%
To evaluate if this improvement is associated with either reduced representations or prolonged length of stay
Targeted QI methodology is associated with sustained improvement in the percent of patients in whom discharge vital signs are obtained when indicated.
Improvement in discharge vital signs was not associated with reduced PED visits
Improvement in discharge vital signs was not associated with prolonged length of stay
Figure 2. Percent of Patients with Discharge Vital Signs When Indicated (P Chart)
Methods
Limitations
Setting: Tertiary care children’s hospital pediatric emergency department (PED)
Population: Patients discharged from the PED with an ESI score of 1, 2 or 3 at triage or those in whom the last set of vital signs was abnormal
Intervention: A multi-disciplinary team developed key drivers to identify areas of intervention which included electronic ordering system updates, best-practice alerts for physicians and nurses, and education (Figure 1).
Measurement: Annotated p-chart, with 8 consecutive points above the mean line indicating special cause variation
Percent of patients with discharge vital signs obtained when indicated (Figure 2)
72 hr return visits based on aggregate data
No data on return and readmission
No data on return rates with or without discharge vital signs on index visit
Implications
Targeted QI interventions can improve the percentage of patients with discharge vital signs when indicated
Discharge vital signs did not negatively affect length of stay
While total 72 hr return data is unchanged with this intervention, further investigation into the affect on readmission rate is warranted