Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data

Abstract

Objectives: The study sought to identify collaborative electronic health record (EHR) usage patterns for pediatric trauma patients and determine how the usage patterns are related to patient outcomes.

Materials and methods: A process mining-based network analysis was applied to EHR metadata and trauma registry data for a cohort of pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The EHR metadata were processed into an event log that was segmented based on gaps in the temporal continuity of events. A usage pattern was constructed for each encounter by creating edges among functional roles that were captured within the same event log segment. These patterns were classified into groups using graph kernel and unsupervised spectral clustering methods. Demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS) of the groups were compared.

Results: Three distinct usage patterns that differed by network density were discovered: fully connected (clique), partially connected, and disconnected (isolated). Compared with the fully connected pattern, encounters with the partially connected pattern had an adjusted median ED LOS that was significantly longer (242.6 [95% confidence interval, 236.9-246.0] minutes vs 295.2 [95% confidence, 289.2-297.8] minutes), more frequently seen among day shift and weekday arrivals, and involved otolaryngology, ophthalmology services, and child life specialists.

Discussion: The clique-like usage pattern was associated with decreased ED LOS for the study cohort, suggesting greater degree of collaboration resulted in shorter stay.

Conclusions: Further investigation to understand and address causal factors can lead to improvement in multidisciplinary collaboration.

Keywords: electronic health record; multidisciplinary collaboration; network analysis; pediatric trauma; process mining.

Figure 1.

Overview of the study design. EHR: electronic health record.

Figure 2.

Summary of the methodological approach to network representation. Each colored circle represents a unique functional role. ED: emergency department.

Figure 3.

Snapshot of the event log structure for the study showing events for encounter with ID 2301. Events for each segment in a shift have the same cluster_id. ED: emergency department; GPS: general pediatric surgery service RN: nurse; AT: attending; R: resident.

Figure 4.

The top 20 functional roles involved across all encounters. ED: emergency department; GPS: general pediatric surgery; PA: physician assistant.

Figure 5.

Determining optimal number of clusters in the similarity matrix. Left: plot of the 10 smallest eigenvalues showing an eigengap at 3. Right: elbow method showing an elbow at 3.

Figure 6.

Iconic example of each usage pattern. Left to right: fully connected (clique-like), partially connected, disconnected. AT: attending; ED: emergency department; F: fellow; GPS: general pediatric surgery; R: resident; Rad_Tech: radiology technician; RN: registered nurse.