The transfer of pediatric patients from an emergency department to another hospital has been repeatedly shown to be a high risk transition. Health care risks are common in pediatrics and have been demonstrated to lead to avoidable harm. Children are a high priority population for patient safety study and improvement. Emergency medical care, as an ambulatory care setting, is a known context of patient safety risk, making emergency medical care a high priority context for risk assessment and safety improvement, particularly the emergency medical services for children. Findings from the AHRQ-funded project, Leveraging Existing Assessments of Risk Now (LEARN) for Pediatric Patient Safety described a set of underlying and interacting generic communication, coordination, and assessment risks across institutions related to the high risk transition of pediatric emergency transfers. Many relatively high frequency and high harm risk processes and conditions related to issues of communication, coordination, and assessment were described in the risk assessments submitted to the LEARN project for review. Health information technologies (HIT) have been advanced as an effective method to address patient safety risks and to improve the safety and reliability of clinician communication across transitions in care. We propose to develop and implement the risk informed intervention of a Web-based Clinical Information Network to support standardized, safe, and reliable clinical communication for pediatric transfers.
The specific aims of this study include:
Aim 1. Determine the pertinent pediatric clinical information required to assure safe, reliable and effective communication, coordination, and assessment of pediatric patient transfers.
Aim 2. Create a Clinical Information Network to standardize the processes and tools for communication, coordination, assessment, and documentation during transfers that includes: a) Age-group specific, standardized tools;b) A Web-based Clinical Information Network on a portal secure access by the receiving and referring hospital's emergency departments;and c) Industrial engineering review of the workflow during transfers to identify and mitigate introduction of new risks.
Aim 3. Implement the Clinical Information Network.
Aim 4. Evaluate the effectiveness of the implementation of the Clinical Information Network.
Aim 5. Evaluate the impact of the Clinical Information Network by comparing transfers to the receiving hospital from the two intervention referring hospitals with transfers from the two control referring hospitals by assessing: a) Improved reliability of the information exchanged during transfers, and b) Improved patient safety.
The transfer of pediatric patients from an emergency department to another hospital has been repeatedly shown to be a high risk transition. Based on the risk findings from the AHRQ-funded LEARN project that identified accurate patient assessment and communication of pertinent clinical information as key challenges to the safe transfer of pediatric patients, the proposed Clinical Information Network for Safe Pediatric Emergency Transfers will directly address clinician communication, coordination, and patient assessment through the development and testing of a standardized process and tools for effective communication to be used during pediatric emergency transfers.
