Implementation of an EHR-Based Emergency Information Form for Children With Medical Complexity

Abstract

Objective: Timely access to concise, accurate clinical information for children with medical complexity (CMC) may improve emergency department (ED) care. Our objective was to improve ED care of CMC via design and implementation of an electronic health record (EHR)-based Emergency Information Form (EIF).

Patients and methods: Using the Model for Improvement, we engaged key stakeholders to develop and implement EIFs. We developed EIFs containing patient summary, prehospital triage instructions, resuscitation status, typical admission diagnoses, medical technologies, critical care needs and plans, and disposition guidelines. We implemented an EHR-based alert to the presence of an EIF. Our primary outcome was time to ED disposition decision. Secondary outcomes were accuracy of EIF and influence on expediting care, measured via clinician survey, and hospital admission rate. Process measures included number of CMC with EIFs, number of ED visits by children with EIFs, and percentage of providers accessing the EIF.

Results: From April 1, 2022, to May 31, 2024, we created and maintained EIFs for 311 CMC who experienced 838 ED visits. Ninety-eight percent and 86% of ED providers agreed or strongly agreed that EIFs contained accurate clinical information and that EIFs expedited care, respectively. A clinician leader-led initiative improved use of EIFs from 42% to 64% over 3 months. Although there was no association between EIFs and time to ED disposition decision, there was a modest reduction in hospitalization rates (53.4% to 50.5%).

Conclusions: We demonstrate the feasibility/utilization of EIFs in the EHR that provide timely and accurate clinical information when accessed, but did not influence ED disposition efficiency.