Abstract
OBJECTIVES: Acute agitation during pediatric mental health emergency department (ED) visits presents safety risks to patients and staff. We previously convened multidisciplinary stakeholders who prioritized 20 proposed quality measures for pediatric acute agitation management. Our objectives were to assess feasibility of evaluating performance on these quality measures using electronic health record (EHR) data and to examine performance variation across 3 EDs. METHODS: At a children’s hospital and 2 nonchildren’s hospitals, we assessed feasibility of evaluating quality measures for pediatric acute agitation management using structured EHR data elements. We retrospectively evaluated measure performance during ED visits by children 5 to 17 years old who presented for a mental health condition, received medication for agitation, or received physical restraints from July 2020 to June 2021. Bivariate and multivariable regression were used to examine measure performance by patient characteristics and hospital. RESULTS: We identified 2785 mental health ED visits, 275 visits with medication given for agitation, and 35 visits with physical restraints. Performance was feasible to measure using EHR data for 10 measures. Nine measures varied by patient characteristics, including 4.87 times higher adjusted odds (95% confidence interval 1.28–18.54) of physical restraint use among children with versus without autism spectrum disorder. Four measures varied by hospital, with physical restraint use varying from 0.5% to 3.3% of mental health ED visits across hospitals. CONCLUSIONS: Quality of care for pediatric acute agitation management was feasible to evaluate using EHR-derived quality measures. Variation in performance across patient characteristics and hospitals highlights opportunities to improve care quality.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 319-327 |
| Number of pages | 9 |
| Journal | Hospital Pediatrics |
| Volume | 14 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2024 |
Funding
Address correspondence to Jennifer A. Hoffmann, MD, MS, Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611. E-mail: [email protected] HOSPITAL PEDIATRICS (ISSN Numbers: Print, 2154-1663; Online, 2154-1671). Dr Hoffmann conceptualized and designed the study, led data collection, analysis, and interpretation, and drafted the initial manuscript; Dr Liu contributed substantially to the conception and design of the study and conducted analyses and interpretation of data; Drs Alpern, Bardach, Cieslak, Corboy, and Pergjika contributed substantially to the conception and design of the study and conducted interpretation of data; Ms Patel conducted data analysis and interpretation; and all authors critically reviewed and revised the manuscript for important intellectual content, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work. FUNDING: Supported by the US Agency for Healthcare Research and Quality (5K12HS026385-03 [to JAH] and U18HS025297 [to NSB]); and supported by the Children\u2019s Research Fund Junior Board [to JAH]. The funders had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the manuscript for publication.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Pediatrics
