420 - Use of a Province-Wide Dashboard to Measure High-Acuity Condition Performance in Diverse Emergency Departments
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 420.6905
Cora E. Laidlaw, University of Calgary, Calgary, AB, Canada; Antonia Stang, University of Calgary, Calgary, AB, Canada; Nona Lailan, Alberta Health Services, Calgary, AB, Canada; Jennifer Thull-Freedman, University of Calgary, Calgary, AB, Canada
Medical Student University of Calgary Calgary, Alberta, Canada
Background: Improving care for severely unwell children requires performance measurement. Previously, our team systematically developed indicators for understanding care quality in six high-acuity pediatric conditions: diabetic ketoacidosis, severe asthma, anaphylaxis, status epilepticus, severe head injury, and severe sepsis, and assessed performance in our pediatric emergency department (ED). The recent introduction of a province-wide electronic health record system (Epic) across all 106 Alberta hospitals provided an opportunity to assess provincial performance. Objective: To measure province-wide performance of pediatric high-acuity condition indicators using an EHR dashboard. Design/Methods: The dashboard was created in 2022 using data from multiple clinical database systems including the National Ambulatory Care Reporting System and Epic. EHR data are automatically updated and visualized in Tableau. Data from January 1-December 31, 2023, were included. Top 5 process or outcome measures for each high acuity condition in the previously published study were selected. Data were extracted and displayed according to hospital type (pediatric or general). Data from the Alberta Children’s Hospital was also displayed separately for comparison to previously published historical data obtained by chart review. Results: Eighteen of the 21 previously published indicators could be measured from the EHR, with 9 maintaining the original definition and 9 requiring modification. Many important data elements were not available in the EHR, such as whether a patient with anaphylaxis received epinephrine prior to ED arrival. Data for each measure is displayed in Table 1. Point estimates did not consistently favor better performance in pediatric versus general hospitals, with point estimates more favorable at the pediatric hospitals in 5 of 17 measures (p=0.24). For example, there were fewer unplanned return visits for asthma among children discharged from pediatric hospitals compared to general hospitals (1.4% vs 2.5%, p< 0.01), whereas children with severe asthma were more likely to have a severity score documented at a children’s hospital (79% vs 72%, p< 0.01).
Conclusion(s): The ED province-wide high acuity condition dashboard promotes understanding of healthcare performance and variation in caring for children in EDs. However, inability to obtain certain clinically important data directly from the EHR or adjust for differences in patient population limits the ability to draw conclusions. Data verification by chart audit would provide valuable validation.
