Background

Individualised Action Plans (APs) are a key management tool for paediatric asthma, allergy, anaphylaxis and eczema. They provide salient care instructions for patients and caregivers and are thought to improve disease outcomes, albeit with minimal supporting evidence. Whilst the provision of an AP has become a widely measured healthcare quality marker, the content of the plans provided has been relatively neglected.

The Royal Children’s Hospital, Melbourne (RCH) implemented an AP generation tool integrated within its Electronic Medical Record (EMR) in 2017. This case study aims to exhibit the potential benefits of a hospital-wide integrated AP tool, assess its uptake and usage at our institution and demonstrate quality and user interface issues detected through audit of APs provided.

Methods

A retrospective observational analysis of all APs created within the RCH EMR for patients aged 0–18 years between January 1 and December 31, 2018 was conducted. For each AP, automatically populated and clinician entered fields were extracted and analysed.

Results

2637 APs were completed during the study period. The most used AP was for asthma. Omission rates of critical information were low but could be improved. Depending on clinical condition, there was variation in both the location of completion (ED vs clinic/hospital visit) and role of clinician completing the AP (consultant vs junior medical staff).

Conclusion

There was considerable uptake of an EMR-integrated AP tool across our institution. An electronic AP allowed for qualitative evaluation of usage and audit of AP content and will guide further system and user interface improvements to improve AP quality.

中文翻译：

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行动计划付诸行动-儿科中心的电子行动计划生成工具。

背景

个性化行动计划（APs）是小儿哮喘，过敏，过敏反应和湿疹的关键管理工具。它们为患者和护理人员提供了重要的护理说明，尽管支持证据很少，但仍被认为可以改善疾病的预后。虽然提供AP已成为衡量医疗保健质量的广泛标准，但所提供计划的内容却相对被忽略了。

墨尔本皇家儿童医院（RCH）于2017年实施了集成在其电子病历（EMR）中的AP生成工具。该案例研究旨在展示医院范围内集成AP工具的潜在优势，评估其在医院的使用和使用情况。我们的机构，并演示通过审核所提供的接入点发现的质量和用户界面问题。

方法

对2018年1月1日至2018年12月31日在RCH EMR中为0-18岁的患者创建的所有AP进行回顾性观察分析。对于每个AP，提取并分析自动填充的和临床医生输入的字段。

结果

在研究期间，完成了2637个AP。最常用的AP是哮喘。重要信息的遗漏率很低，但可以改善。根据临床情况，完成位置（ED与临床/医院就诊）和临床医师完成AP的角色（顾问与初级医疗人员）均存在差异。

结论

我们机构中大量采用了EMR集成的AP工具。电子AP可以对AP使用情况进行质量评估并审核AP内容，并将指导进一步的系统和用户界面改进，以提高AP质量。