Optimizing Critical Care Documentation in a Pediatric Emergency Department.
Document Type
Article
Publication Date
2-1-2022
Identifier
DOI: 10.1097/PEC.0000000000002446
Abstract
OBJECTIVE: Emergency department (ED) physicians frequently provide critical care (CC) but document inconsistently. Variability in documentation can result in underbilling and is inconsistent with financial stewardship. We used admissions to the intensive care unit (ICU) as a proxy for CC provision. At baseline, CC notes were correctly documented for 20% of eligible visits, with potential missed charges of $1.8 million per year.Our objective was to increase CC note placement for eligible patients from 20% to 60% over 2 years. Additionally, we measured CC notes and the number of ICU admissions per 1000 ED visits, and change in facility fees.
METHODS: We performed this project at a midwestern quaternary children's hospital with 2 EDs (combined volume 120,000 visits/year). We surveyed the ED physicians to inform our interventions. We used maintenance of certification points and financial incentives for quality improvement work to obtain buy-in. We used serial interventions with plan-do-study-act cycles: (1) CC note simplification, (2) education, (3) follow-up surveys, (4) additional location for CC note, and (5) timely reminders. We reviewed sample charts and used χ2 test and control charts for analysis.
RESULTS: Critical care note placement for ICU admissions increased from 20% to 60% in 8 months, and further to greater than 75%. The CC notes increased from 4 to 16 per 1000 ED visits. Intensive care unit admissions increased but remained appropriate. The billed facility fee for CC increased by 263%.
CONCLUSIONS: This project resulted in significant and sustained improvements in CC note completion. We believe providing education, simplifying the documentation process, automating reminders, and incentivizing optimal documentation were vital to success.
Journal Title
Pediatric emergency care
Volume
38
Issue
2
First Page
997
Last Page
1002
MeSH Keywords
Child; Critical Care; Documentation; Emergency Service, Hospital; Hospitals, Pediatric; Humans; Intensive Care Units
Keywords
Critical Care; Documentation; Hospital Emergency Service; Pediatric Hospitals; Intensive Care Units
Recommended Citation
Jain S, Shastri NJ, Sharma N, Conners GP. Optimizing Critical Care Documentation in a Pediatric Emergency Department. Pediatr Emerg Care. 2022;38(2):e997-e1002. doi:10.1097/PEC.0000000000002446
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