Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Background: Mild traumatic brain injuries (mTBI) or concussions account for high rates of emergency department (ED) visits. Concussion diagnoses are used less often in young children leading to a variability in parental education and discharge instructions. Lack of discharge guidance may increase parental anxiety, impact recovery, and increase ED visits.
Objectives: To increase the proportion of ED patients discharged with age-appropriate instructions for mTBI by 50% by June 1, 2024, and to determine the impact age-appropriate instructions have on decreasing parental anxiety.
Methods: This observational time series with planned sequential experimentation is in progress at a Pediatric ED affiliated with an urban academic medical center from October 2022- June 2024. All pediatric ED patients aged 0-18 years with mTBI or concussion associated ICD-10 codes were included. An interdisciplinary team including ED faculty, pediatric neurology, nursing, clinical informatics, and QI specialist developed the key driver diagram. Interventions derived from tertiary drivers included ED staff education and creation of an electronic medical record (EMR) smart phrase of standardized discharge instructions for mTBI or concussion for children ages 0-5 years and ≥ 6 years based on CDC guidelines and expert consensus. Data were collected via EMR review. Our process measures included percentage of patients who received discharge instructions with 1) head injury specific precautions, 2) cognitive and 3) physical limitations, age-appropriate instructions related to 4) cognitive and 5) physical limitations and 6) clinical diagnosis of concussion. Our balancing measures include head CT utilization. Data were displayed and analyzed using statistical process control “P” charts and API rules were applied to detect special cause variation.
Results: In 976 patients, we observed an improvement in the percentage of patients who received age-appropriate instructions for both cognitive and physical limitations from a mean of 79% to 95%, following the implementation of our smart phrases. Parental surveys during Feb – Mar 2024 indicated 63% of parents found discharge instructions were very helpful in alleviating their stress and 80% of parents found age-appropriate discharge instructions very helpful while watching over their child in their recovery period.There was no increase in head CT utilization.
Conclusions: Creating age-appropriate standardized EMR discharge smart phrases for physical and cognitive recovery led to increased incorporation of these discharge instructions from the Pediatric ED. Parental surveys provided feedback and illustrated the impact of age-appropriate discharge instructions on parents/guardians caring for children during recovery from mTBI or concussions. Disparities in the use of smart phrase across racial/ethnic populations will be further investigated and incorporated into educational curriculum.
Keywords
traumatic brain injury, mtbi, concussion, pediatrics, emergency department, age-appropriate, discharge instructions, smart phrases, parental anxiety, Patient Discharge Summaries, Patient Education as Topic
Disciplines
Emergency Medicine | Health Services Research | Medicine and Health Sciences | Neurology | Pathological Conditions, Signs and Symptoms | Patient Safety | Pediatrics | Psychological Phenomena and Processes | Public Health Education and Promotion
Document Type
Poster
Included in
Emergency Medicine Commons, Health Services Research Commons, Neurology Commons, Pathological Conditions, Signs and Symptoms Commons, Patient Safety Commons, Pediatrics Commons, Psychological Phenomena and Processes Commons, Public Health Education and Promotion Commons
Standardization of Discharge Instructions for Mild Traumatic Brain Injury/Concussion in Children Presenting to ED: A QI Project
Background: Mild traumatic brain injuries (mTBI) or concussions account for high rates of emergency department (ED) visits. Concussion diagnoses are used less often in young children leading to a variability in parental education and discharge instructions. Lack of discharge guidance may increase parental anxiety, impact recovery, and increase ED visits.
Objectives: To increase the proportion of ED patients discharged with age-appropriate instructions for mTBI by 50% by June 1, 2024, and to determine the impact age-appropriate instructions have on decreasing parental anxiety.
Methods: This observational time series with planned sequential experimentation is in progress at a Pediatric ED affiliated with an urban academic medical center from October 2022- June 2024. All pediatric ED patients aged 0-18 years with mTBI or concussion associated ICD-10 codes were included. An interdisciplinary team including ED faculty, pediatric neurology, nursing, clinical informatics, and QI specialist developed the key driver diagram. Interventions derived from tertiary drivers included ED staff education and creation of an electronic medical record (EMR) smart phrase of standardized discharge instructions for mTBI or concussion for children ages 0-5 years and ≥ 6 years based on CDC guidelines and expert consensus. Data were collected via EMR review. Our process measures included percentage of patients who received discharge instructions with 1) head injury specific precautions, 2) cognitive and 3) physical limitations, age-appropriate instructions related to 4) cognitive and 5) physical limitations and 6) clinical diagnosis of concussion. Our balancing measures include head CT utilization. Data were displayed and analyzed using statistical process control “P” charts and API rules were applied to detect special cause variation.
Results: In 976 patients, we observed an improvement in the percentage of patients who received age-appropriate instructions for both cognitive and physical limitations from a mean of 79% to 95%, following the implementation of our smart phrases. Parental surveys during Feb – Mar 2024 indicated 63% of parents found discharge instructions were very helpful in alleviating their stress and 80% of parents found age-appropriate discharge instructions very helpful while watching over their child in their recovery period.There was no increase in head CT utilization.
Conclusions: Creating age-appropriate standardized EMR discharge smart phrases for physical and cognitive recovery led to increased incorporation of these discharge instructions from the Pediatric ED. Parental surveys provided feedback and illustrated the impact of age-appropriate discharge instructions on parents/guardians caring for children during recovery from mTBI or concussions. Disparities in the use of smart phrase across racial/ethnic populations will be further investigated and incorporated into educational curriculum.