Patient Portal Enrollment for Discharged Pediatric Emergency Department Patients: A Multidisciplinary Quality Improvement Project

Abstract

Introduction: Patient portal enrollment following pediatric emergency department (ED) visits allows access to critical results, physician documentation, and telehealth follow-up options. Despite these advantages, there are many challenges to portal invitation and enrollment. Our primary objective was to improve patient portal enrollment rates for discharged pediatric ED patients.

Methods: A multidisciplinary team of staff from two ED sites developed successful portal enrollment interventions through sequential Plan-Do-Study-Act cycles from October 2020 to October 2021. Interventions included a new invitation process, changes to patient paperwork on ED arrival, staff portal education, and changes to discharge paperwork and the portal website. The team utilized statistical process control charts to track the percentage of eligible discharged patients who received a portal invitation (process measure) and enrolled in the patient portal.

Results: Before the study's initiation, less than 1% of eligible patients received patient portal invites or enrolled in the patient portal. Statistical process control charts revealed significant changes in enrollment and baseline shift at both a large academic ED campus and a satellite ED site by May 2021. Improvements in invitation rates were also observed at both campuses. Changes were sustained for over 6 months at both locations.

Conclusions: High-reliability interventions and a multidisciplinary approach allowed for significant and sustained improvement in patient portal invitation and enrollment rates in eligible pediatric ED patients. Future study will examine enrollment patterns across patient demographics and further high-reliability interventions.

Fig. 1.

Key driver diagram of patient portal enrollment initiative in the ED including all pertinent interventions.

Fig. 2.

P-chart SPC chart demonstrating weekly percentage of eligible patients newly enrolled in the patient portal within 10 days of discharge from the ED at a larger freestanding children’s hospital (A) and a smaller satellite ED site (B). Project goal was to increase this percentage (arrow) with a goal of 5% or more at each site. Y-axis ends at 20% for size and ease of interpretation. Percent of Eligible Patients Enrolled per Week

Fig. 3.

P-chart SPC chart demonstrating weekly percentage of eligible patients invited to the patient portal within 7 days of discharge from the ED at a larger freestanding children’s hospital (A) and a smaller satellite ED site (B). Project goal was to increase this percentage (arrow) with a goal of 20% or more at each site. Y-axis ends at 50% for size and ease of interpretation. Percent of Eligible Patients Enrolled per Week