Cincinnati Children's Hospital
Objectives: The primary aim of this study was to determine key factors associated with algorithm adherent care in the pediatric emergency department. We hypothesized that order set use and resident involvement in care would be significant factors in adherence. Our secondary objective aimed to explore resident specific factors associated with increased adherence. We hypothesized that more experienced residents would provide adherent care more often.
Methods: We performed a retrospective chart review of patients over the age of two presenting to a CCHMC emergency department between July 1st, 2017 and June 30th, 2018 with a diagnosis of asthma exacerbation.
Results: There were 2286 patient encounters included in our sample. Overall, 54.9% of these patients received algorithm adherent care as defined by our clinical care pathway. Both order set use (OR 2.356; 95% CI 1.859-2.987) and resident involvement in care (OR 1.265; 95% CI 1.035- 1.546) were associated with increased algorithm adherence. Experienced residents, as defined by post graduate year in training and number of encounters within our sample, were not associated with increased algorithm adherence. Resident program type was found to be a significant factor in association with algorithm adherent care.
Conclusions: Overall, we aim for 80% adherence to standardized care algorithms. Emergency departments often fall below this goal. There are certain factors associated with increased adherence upon which we should pay attention. Order set use has been previously shown to increase adherence and we again show that here. We also show that resident involvement in care is associated with increased adherence as compared to patient encounters without a resident. While we did not show that adherence increases with resident experience as expected, further exploration of these resident specific factors is warranted.
