Implementing Discharge Vital Signs in the Pediatric Emergency

Implementing Discharge Vital Signs in the Pediatric Emergency

Implementing Discharge Vital Signs in the Pediatric Emergency
Department
Adam A Vukovic, MD, MEd1, 2; Corrie Berry, RN, MMHC, BSN, CPEN2
1. Department of Pediatrics; 2. Pediatric Emergency Medicine, Monroe Carell Jr. Childrens Hospital at Vanderbilt

Background
Vital sign abnormalities are an important data point for patients in the pediatric

Results
Figure 1. Key Driver Diagram

emergency department (PED)
Tachycardia has been associated with representation and readmission
Tools such as the emergency severity index (ESI) have been developed to aid
in triaging and identifying ill patients
These tools drive vital sign reassessment
Nature of the PED hinders vital sign reassessment and impedes situational
awareness

2. To evaluate if this improvement is associated with either
reduced representations or prolonged length of stay

Methods
Setting: Tertiary care childrens hospital pediatric
emergency department (PED)
Population: Patients discharged from the PED with an ESI
score of 1, 2 or 3 at triage or those in whom the last set of
vital signs was abnormal
Intervention: A multi-disciplinary team developed key
drivers to identify areas of intervention which included
electronic ordering system updates, best-practice alerts for
physicians and nurses, and education (Figure 1).
Measurement: Annotated p-chart, with 8 consecutive
points above the mean line indicating special cause
variation
Percent of patients with discharge vital signs obtained
when indicated (Figure 2)

Data were collected for 16 months
14,872 patients included
3,909 out of 7010 (56%) patients had discharge vital signs
performed when indicated
Manual discharge vital sign order entry improved
discharge vital signs from 21.4% to 40.8%
Targeted QI methodology further improved discharge vital
signs from 40.8% to 84.6%
There were no differences in 72 hr return visits or total
length of stay for patients discharged on index visit (not
shown)

Objectives
1. To use quality improvement (QI) methodology to improve
the percent of patients discharged from the pediatric
emergency department (PED) with a complete set of vital
signs, when indicated, from a baseline of 20% to 95%

Results, continued

Conclusions
Targeted QI methodology is associated with sustained

Figure 2. Percent of Patients with Discharge Vital Signs When Indicated (P
Chart)

improvement in the percent of patients in whom discharge
vital signs are obtained when indicated.
Improvement in discharge vital signs was not associated
with reduced PED visits
Improvement in discharge vital signs was not associated
with prolonged length of stay

Limitations
72 hr return visits based on aggregate data
No data on return and readmission
No data on return rates with or without discharge vital
signs on index visit

Implications
Targeted QI interventions can improve the percentage of
patients with discharge vital signs when indicated
Discharge vital signs did not negatively affect length of stay
While total 72 hr return data is unchanged with this
intervention, further investigation into the affect on
readmission rate is warranted

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