Electronic medical record–based tools aid in timely triage of disc-shaped foreign body ingestions

Jennifer M Lavin*, Joshua Wiedermann, Alexandra Sals, Kimberly Kato, Dusty Brinson, Agata Nytko, Yiannis L Katsogridakis, Steven E Krug, Jonathan B Ida

*Corresponding author for this work

Research output: Contribution to journalReview article

Abstract

Objectives/Hypothesis: Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. Study Design: Quality initiative. Methods: A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016–January 28, 2017) and postinitiative (January 31, 2017–August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. Results: Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8% (23/36) pre implementation to 100% (30/30) postimplementation (P =.0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95% confidence interval [CI]: −44 to −17) and 59 to 41 minutes (95% CI: −39 to −1), respectively. Conclusions: Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. Level of Evidence: NA Laryngoscope, 128:2697–2701, 2018.

Original languageEnglish (US)
Pages (from-to)2697-2701
Number of pages5
JournalLaryngoscope
Volume128
Issue number12
DOIs
StatePublished - Dec 2018

Fingerprint

Medical Electronics
Triage
Foreign Bodies
Eating
Numismatics
Electronic Health Records
X-Rays
Confidence Intervals
Laryngoscopes
Practice Guidelines
Hospital Emergency Service
Wounds and Injuries

Keywords

  • Electronic medical record
  • button battery
  • clinical decision support
  • esophageal foreign body
  • ingestion

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Lavin, Jennifer M ; Wiedermann, Joshua ; Sals, Alexandra ; Kato, Kimberly ; Brinson, Dusty ; Nytko, Agata ; Katsogridakis, Yiannis L ; Krug, Steven E ; Ida, Jonathan B. / Electronic medical record–based tools aid in timely triage of disc-shaped foreign body ingestions. In: Laryngoscope. 2018 ; Vol. 128, No. 12. pp. 2697-2701.
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title = "Electronic medical record–based tools aid in timely triage of disc-shaped foreign body ingestions",
abstract = "Objectives/Hypothesis: Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. Study Design: Quality initiative. Methods: A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016–January 28, 2017) and postinitiative (January 31, 2017–August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. Results: Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8{\%} (23/36) pre implementation to 100{\%} (30/30) postimplementation (P =.0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95{\%} confidence interval [CI]: −44 to −17) and 59 to 41 minutes (95{\%} CI: −39 to −1), respectively. Conclusions: Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. Level of Evidence: NA Laryngoscope, 128:2697–2701, 2018.",
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author = "Lavin, {Jennifer M} and Joshua Wiedermann and Alexandra Sals and Kimberly Kato and Dusty Brinson and Agata Nytko and Katsogridakis, {Yiannis L} and Krug, {Steven E} and Ida, {Jonathan B}",
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Electronic medical record–based tools aid in timely triage of disc-shaped foreign body ingestions. / Lavin, Jennifer M; Wiedermann, Joshua; Sals, Alexandra; Kato, Kimberly; Brinson, Dusty; Nytko, Agata; Katsogridakis, Yiannis L; Krug, Steven E; Ida, Jonathan B.

In: Laryngoscope, Vol. 128, No. 12, 12.2018, p. 2697-2701.

Research output: Contribution to journalReview article

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AU - Lavin, Jennifer M

AU - Wiedermann, Joshua

AU - Sals, Alexandra

AU - Kato, Kimberly

AU - Brinson, Dusty

AU - Nytko, Agata

AU - Katsogridakis, Yiannis L

AU - Krug, Steven E

AU - Ida, Jonathan B

PY - 2018/12

Y1 - 2018/12

N2 - Objectives/Hypothesis: Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. Study Design: Quality initiative. Methods: A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016–January 28, 2017) and postinitiative (January 31, 2017–August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. Results: Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8% (23/36) pre implementation to 100% (30/30) postimplementation (P =.0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95% confidence interval [CI]: −44 to −17) and 59 to 41 minutes (95% CI: −39 to −1), respectively. Conclusions: Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. Level of Evidence: NA Laryngoscope, 128:2697–2701, 2018.

AB - Objectives/Hypothesis: Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. Study Design: Quality initiative. Methods: A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016–January 28, 2017) and postinitiative (January 31, 2017–August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. Results: Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8% (23/36) pre implementation to 100% (30/30) postimplementation (P =.0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95% confidence interval [CI]: −44 to −17) and 59 to 41 minutes (95% CI: −39 to −1), respectively. Conclusions: Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. Level of Evidence: NA Laryngoscope, 128:2697–2701, 2018.

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KW - button battery

KW - clinical decision support

KW - esophageal foreign body

KW - ingestion

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