Electronic medical record based tools: Not a panacea in the diagnosis of coin-shaped foreign bodies.

INTRODUCTION: Electronic medical record-based tools have been demonstrated to improve timeliness of x-ray order placement in patients presenting to the emergency department (ED) with coin-shaped foreign body ingestion. Similar efforts directed towards downstream processes are necessary to expedite diagnosis of an esophageal button battery. We predicted that improvement tools such as electronic medical record-based alerts and process standardization could be utilized to expedite x-ray completion. METHODS: Using Plan, Do, Study, Act methodology, iterative interventions were implemented. In July 2017 a previously designed best practice advisory was linked to an automated notification page to the x-ray technician. Next, a standardized process was created where patients were gowned in triage and placed in a designated space awaiting x-ray. Workflow planning began in December 2018 and was formalized in February 2019. Time from arrival to x-ray completion was tracked for patients presenting with coin-shaped foreign body ingestion. Control charts were used to determine special cause variation. RESULTS: An average of 10.1 patients (Range 4-21) presented monthly to the ED with coin-shaped foreign body ingestion. Automated pages to the x-ray technician were not associated with improved time to x-ray completion. Upon initiation of the new patient workflow, median time to x-ray completion decreased from 37.4 to 23.3 min. CONCLUSION: Time to x-ray completion in children presenting to the ED with ingestion of coin-shaped foreign bodies is not improved solely through electronic notification of the imaging technologist. Efforts to standardize processes for patient intake and placement are associated with more timely completion of imaging studies. Generalizability of findings may depend on contextual elements of individual healthcare units.

Electronic medical record-based tools aid in timely triage of disc-shaped foreign body ingestions.

OBJECTIVES/HYPOTHESIS: Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. STUDY DESIGN: Quality initiative. METHODS: A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016-January 28, 2017) and postinitiative (January 31, 2017-August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. RESULTS: Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8% (23/36) pre implementation to 100% (30/30) postimplementation (P = .0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95% confidence interval [CI]: -44 to -17) and 59 to 41 minutes (95% CI: -39 to -1), respectively. CONCLUSIONS: Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. LEVEL OF EVIDENCE: NA Laryngoscope, 128:2697-2701, 2018.