TY - JOUR
T1 - Electronic medical record based tools
T2 - Not a panacea in the diagnosis of coin-shaped foreign bodies
AU - Lavin, Jennifer M.
AU - Corboy, Jacqueline
AU - Katsogridakis, Yiannis
AU - Pham, Oanh K.
AU - Brinson, Dusty
AU - Krug, Steve
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2023/1
Y1 - 2023/1
N2 - Introduction: Electronic medical record-based tools have been demonstrated to improve timeliness of x-ray order placement in patients presenting to the emergency department (ED) with coin-shaped foreign body ingestion. Similar efforts directed towards downstream processes are necessary to expedite diagnosis of an esophageal button battery. We predicted that improvement tools such as electronic medical record-based alerts and process standardization could be utilized to expedite x-ray completion. Methods: Using Plan, Do, Study, Act methodology, iterative interventions were implemented. In July 2017 a previously designed best practice advisory was linked to an automated notification page to the x-ray technician. Next, a standardized process was created where patients were gowned in triage and placed in a designated space awaiting x-ray. Workflow planning began in December 2018 and was formalized in February 2019. Time from arrival to x-ray completion was tracked for patients presenting with coin-shaped foreign body ingestion. Control charts were used to determine special cause variation. Results: An average of 10.1 patients (Range 4–21) presented monthly to the ED with coin-shaped foreign body ingestion. Automated pages to the x-ray technician were not associated with improved time to x-ray completion. Upon initiation of the new patient workflow, median time to x-ray completion decreased from 37.4 to 23.3 min. Conclusion: Time to x-ray completion in children presenting to the ED with ingestion of coin-shaped foreign bodies is not improved solely through electronic notification of the imaging technologist. Efforts to standardize processes for patient intake and placement are associated with more timely completion of imaging studies. Generalizability of findings may depend on contextual elements of individual healthcare units.
AB - Introduction: Electronic medical record-based tools have been demonstrated to improve timeliness of x-ray order placement in patients presenting to the emergency department (ED) with coin-shaped foreign body ingestion. Similar efforts directed towards downstream processes are necessary to expedite diagnosis of an esophageal button battery. We predicted that improvement tools such as electronic medical record-based alerts and process standardization could be utilized to expedite x-ray completion. Methods: Using Plan, Do, Study, Act methodology, iterative interventions were implemented. In July 2017 a previously designed best practice advisory was linked to an automated notification page to the x-ray technician. Next, a standardized process was created where patients were gowned in triage and placed in a designated space awaiting x-ray. Workflow planning began in December 2018 and was formalized in February 2019. Time from arrival to x-ray completion was tracked for patients presenting with coin-shaped foreign body ingestion. Control charts were used to determine special cause variation. Results: An average of 10.1 patients (Range 4–21) presented monthly to the ED with coin-shaped foreign body ingestion. Automated pages to the x-ray technician were not associated with improved time to x-ray completion. Upon initiation of the new patient workflow, median time to x-ray completion decreased from 37.4 to 23.3 min. Conclusion: Time to x-ray completion in children presenting to the ED with ingestion of coin-shaped foreign bodies is not improved solely through electronic notification of the imaging technologist. Efforts to standardize processes for patient intake and placement are associated with more timely completion of imaging studies. Generalizability of findings may depend on contextual elements of individual healthcare units.
KW - Button battery
KW - Electronic medical record
KW - Esophageal foreign body
KW - Ingestion
KW - Quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85143983707&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85143983707&partnerID=8YFLogxK
U2 - 10.1016/j.ijporl.2022.111410
DO - 10.1016/j.ijporl.2022.111410
M3 - Article
C2 - 36529040
AN - SCOPUS:85143983707
SN - 0165-5876
VL - 164
JO - International journal of pediatric otorhinolaryngology
JF - International journal of pediatric otorhinolaryngology
M1 - 111410
ER -