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Pilot intervention to improve the documentation of pediatric injuries in the emergency department

Published online by Cambridge University Press:  21 May 2015

Donald C. Voaklander ,
Garnet E. Cummings ,
Kim Borden ,
Carla Policicchio  and
Joanne Vincenten
Donald C. Voaklander*
Affiliation:
Department of Rural Health, University of Melbourne, Victoria, Australia
Garnet E. Cummings
Affiliation:
Royal Alexandra Hospital, Edmonton, Alta
Kim Borden
Affiliation:
Alberta Centre Injury for Control and Research, Edmonton
Carla Policicchio
Affiliation:
Royal Alexandra Hospital, Edmonton, Alta
Joanne Vincenten
Affiliation:
Alberta Centre Injury for Control and Research, Edmonton
*
Department of Rural Health, University of Melbourne, PO Box 6500, Shepparton, Victoria 3632, Australia; tel +61 3 5831 6036, fax +61 3 5831 6435; don@unimelb.edu.au

Abstract

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Objective:

Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries.

Methods:

All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injuryspecific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Postintervention documentation was compared to pre-intervention documentation for the 14 predefined data elements.

Results:

Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting “the presence of an adult observer” to 0.09 (95%CI, 0.01 to 0.76) for charting “sports equipment related to the injury.” The “flagging” of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention.

Conclusion:

A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.

Keywords

emergency departmentdocumentationsurveillance
Type
EM Advances • Progrès De La MU
Information
Canadian Journal of Emergency Medicine , Volume 2 , Issue 4 , October 2000 , pp. 252 - 257
Copyright
Copyright © Canadian Association of Emergency Physicians 2000

References

1.Last, JM.A dictionary of epidemiology, 3rd ed. Toronto: Oxford University Press; 1995.Google Scholar
2.Laboratory Centre for Disease Control. Children’s Hospitals Injury Research and Prevention Program (CHIRPP). Technical report #2. Ottawa: The Centre; 1991.Google Scholar
3.Baker, SP., O’Neill, B., Ginsburg, MJ., Guohua, LI.The injury fact book, 2nd ed. New York: Oxford University Press; 1992.Google Scholar
4.Deane, M.Child accident data: Accessible and available? J Public Health Med 1993;15:226–8.Google Scholar
5.Trampolines at home, school, and recreational centers. American Academy of Pediatrics. Committee on Injury and Poison Prevention and Committee on Sports Medicine and Fitness. Pediatrics 1999;103:1053–6.Google Scholar
6.Woodward, GA., Furnival, R., Schunk, JE.Trampolines revisited a review of 114 pediatric recreational trampoline injuries. Pediatrics 1992;89:849–54.Google Scholar
7.Larson, BJ., Davis, JW.Trampoline-related injuries. J Bone Joint Surg [Am] 1995;77:1174–8.Google Scholar
8.Hume, PA., Chalmers, DJ., Wilson, BD.Trampoline injury in New Zealand: emergency care. Br J Sports Med 1996;30:327–30.Google Scholar
9.Furnival, RA., Street, KA., Schunk, JE.Too many pediatric trampoline injuries. Pediatrics 1999;103:e57.Google Scholar
10.Smith, GA.Injuries to children in the United States related to trampolines, 1990–1995: a national epidemic. Pediatrics 1998; 101:406–12.Google Scholar
11.Smith, GA., Shields, BJ.Trampoline-related injuries to children. Arch Pediatr Adolesc Med 1998;152:694–9.Google Scholar
12.Williams, JM., Furbee, PM., Prescott, JE., Paulson, DJ.The emergency department log as a simple injury-surveillance tool. Ann Emerg Med 1995;25:686–91.Google Scholar
13.Smith, GS., Langley, JD.Drowning surveillance: How well do E codes identify submersion fatalities? Injury Prev 1998;4:135–9.Google Scholar
14.Guyer, B.Injury prevention: meeting the challenge. New York: Oxford University Press; 1989.Google Scholar
15.Monash University Accident Research Centre. Injury research and prevention: a text. Melbourne: The Centre; 1995.Google Scholar
16.Campbell, JP., Maxey, VA., Watson, WA.Hawthorne effect: implications for prehospital research. Ann Emerg Med 1995;26:590–4.Google Scholar
17.Cohen, J.Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Erlbaum Associates; 1988.Google Scholar
18.Langlois, JA., Buechner, JS., O’Connor, EA., Nacar, EQ., Smith, GS.Improving the E coding of hospitalizations for injury: Do hospital records contain adequate documentation? Am J Public Health 1995;85:1261–5.Google Scholar
19.Schwartz, DF.It is time to get serious about childhood injury surveillance in the United States [editorial]. Am J Prev Med 1995; 11:134–5.Google Scholar
20.Schwartz, RJ., Boisoneau, D., Jacobs, LM.The quality of cause-of-injury information documented on the medical record: an appeal for injury prevention. Acad Emerg Med 1995;2:98–103.Google Scholar
21.Beattie, TF.An accident and emergency based child accident surveillance system: Is it possible? J Accid Emerg Med 1996; 13:116–8.Google Scholar
22.Christopher, NC., Anderson, D., Gaertner, L., Roberts, D., Wasser, TE.Childhood injuries and the importance of documentation in the emergency department. Pediatr Emerg Care 1995;11:52–7.Google Scholar
23.Humphries, T., Shofer, FS., Jacobson, S., Coutifaris, C., Stemhagen, A.Preformatted charts improve the documentation in the emergency department. Ann Emerg Med 1992;21:534–40.Google Scholar
24.Wrenn, K., Rodewald, L., Lumb, E., Slovis, C.The use of structured, complaint-specific patient encounter forms in the emergency department. Ann Emerg Med 1993;22:805–12.Google Scholar
25.Wallace, SA., Gullan, RW., Byrne, PO., Bennett, J., Perez-Avila, CA.Use of a pro forma for head injuries in the accident and emergency department — the way forward. J Accid Emerg Med 1994;11:33–42.Google Scholar