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Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support

BACKGROUND: For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of...

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Autores principales: Atabaki, Shireen M., Jacobs, Brian R., Brown, Kathleen M., Shahzeidi, Samira, Heard-Garris, Nia J., Chamberlain, Meghan B., Grell, Robert M., Chamberlain, James M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132459/
https://www.ncbi.nlm.nih.gov/pubmed/30229157
http://dx.doi.org/10.1097/pq9.0000000000000019
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author Atabaki, Shireen M.
Jacobs, Brian R.
Brown, Kathleen M.
Shahzeidi, Samira
Heard-Garris, Nia J.
Chamberlain, Meghan B.
Grell, Robert M.
Chamberlain, James M.
author_facet Atabaki, Shireen M.
Jacobs, Brian R.
Brown, Kathleen M.
Shahzeidi, Samira
Heard-Garris, Nia J.
Chamberlain, Meghan B.
Grell, Robert M.
Chamberlain, James M.
author_sort Atabaki, Shireen M.
collection PubMed
description BACKGROUND: For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our electronic health record (EHR) to reduce CT. OBJECTIVE: To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs. METHODS: We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] decision support implementation. The primary outcome was change in CT use rate over time, measured using statistical process control charts. Secondary analyses included multivariate comparisons of PRE to POST. Balancing measures included ED length of stay and returns within 7 days after ED release. RESULTS: There were 2,878 patients with head trauma (1,329 PRE and 1,549 POST) included. Statistical process control charts confirmed decreased CT rates over time POST that was not present PRE. Secondary statistical analyses confirmed that CT scan utilization rates decreased from 26.8% to 18.9% (unadjusted Odds Ratio [OR], 0.64; 95% Confidence Interval [CI], 0.53 -0.76; adjusted OR, 0.71; 95% CI, 0.58 -0.86). Length of stay was unchanged. There was no increase in returns within 7 days and no significant missed diagnoses. CONCLUSIONS: Implementation of EHR-integrated decision support for children with head trauma presenting to the ED is associated with a decrease in CT utilization and no increase in significant safety events.
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spelling pubmed-61324592018-09-18 Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support Atabaki, Shireen M. Jacobs, Brian R. Brown, Kathleen M. Shahzeidi, Samira Heard-Garris, Nia J. Chamberlain, Meghan B. Grell, Robert M. Chamberlain, James M. Pediatr Qual Saf Individual QI Projects from Single Institutions BACKGROUND: For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our electronic health record (EHR) to reduce CT. OBJECTIVE: To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs. METHODS: We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] decision support implementation. The primary outcome was change in CT use rate over time, measured using statistical process control charts. Secondary analyses included multivariate comparisons of PRE to POST. Balancing measures included ED length of stay and returns within 7 days after ED release. RESULTS: There were 2,878 patients with head trauma (1,329 PRE and 1,549 POST) included. Statistical process control charts confirmed decreased CT rates over time POST that was not present PRE. Secondary statistical analyses confirmed that CT scan utilization rates decreased from 26.8% to 18.9% (unadjusted Odds Ratio [OR], 0.64; 95% Confidence Interval [CI], 0.53 -0.76; adjusted OR, 0.71; 95% CI, 0.58 -0.86). Length of stay was unchanged. There was no increase in returns within 7 days and no significant missed diagnoses. CONCLUSIONS: Implementation of EHR-integrated decision support for children with head trauma presenting to the ED is associated with a decrease in CT utilization and no increase in significant safety events. Wolters Kluwer Health 2017-05-16 /pmc/articles/PMC6132459/ /pubmed/30229157 http://dx.doi.org/10.1097/pq9.0000000000000019 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Individual QI Projects from Single Institutions
Atabaki, Shireen M.
Jacobs, Brian R.
Brown, Kathleen M.
Shahzeidi, Samira
Heard-Garris, Nia J.
Chamberlain, Meghan B.
Grell, Robert M.
Chamberlain, James M.
Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
title Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
title_full Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
title_fullStr Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
title_full_unstemmed Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
title_short Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
title_sort quality improvement in pediatric head trauma with pecarn rules implementation as computerized decision support
topic Individual QI Projects from Single Institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132459/
https://www.ncbi.nlm.nih.gov/pubmed/30229157
http://dx.doi.org/10.1097/pq9.0000000000000019
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