Improving the Quality of Pediatric Emergency Care Using an Electronic Medical Record Registry and Clinician Feedback

Twenty percent of children in the U.S. have at least one emergency department (ED) visit each year. While EDs routinely collect patient data, the capacity to analyze and report these data back to front-line clinicians, who can act to improve healthcare delivery, is limited. With electronic health record (EHR) data, researchers can measure variations in provider performance and patient health outcomes, and design and implement interventions to improve outcomes and quality of care across multiple settings. EHR registries are population focused, purpose driven, and designed to derive information on health outcomes from multiple EHR systems. They allow for robust data to be derived directly from the patient clinical record and can provide important healthcare quality information.

This project extracted EHR data from two vendors and four hospital systems within the Pediatric Emergency Care Applied Research Network (PECARN). Researchers developed a registry tool to track, report, and improve the quality of emergency care for children. They also collected and reported quality measures of emergency care and patient demographics, including race and ethnicity, within and across sites of care.

The specific aims of the project were as follows:

• Develop an emergency care visit registry for pediatric patients from merged EHR clinical data from different hospital EDs with differing EHR data sources. 
• Use the registry to collect and determine benchmarks of care for stakeholder-prioritized emergency care performance measures for important pediatric medical and trauma conditions at the level of both the ED and individual clinician. 
• Use this registry to report performance to individual ED clinicians and sites. 

Researchers used EHR clinical data to create the PECARN Registry, which is comprised of 176 distinct ED visit variables including patient demographics, vital signs, clinical scores, clinical documentation, laboratory and imaging results, and orders related to ED care. They utilized the registry to create and evaluate emergency care performance measures for pediatric conditions and derived benchmarks for each measure.

The PECARN Registry contains data from 2,250,444 pediatric ED visits, 911,239 distinct patients, more than 13.7 million narrative reports, and 13,920,477 laboratory tests. Investigators developed and distributed monthly performance report cards to more than 475 clinicians and 50 sites on overall performance. As an example of quality performance measure evaluation, researchers assessed racial and ethnic differences related to unnecessary antibiotics and found that compared to white children, black and Hispanic children were less likely to receive unnecessary antibiotics for viral acute respiratory tract infections in the ED. Data from the PECARN Registry has been used for quality improvement audits and feedback, as well as health services research. The registry demonstrated that emergency care data from disparate health systems and EHR vendors can be harmonized for use in a single tool.