42 - Performance Variation in Quality Measures for Pediatric Acute Agitation Management in the Emergency Department

Poster Number: 42
Publication Number: 42.406

Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Kristine Cieslak, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Xiaohong Liu, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Alba Pergjika, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Tulsi Patel, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Jacqueline B. Corboy, Ann & Robert H. Lurie Children's Hospital of Chica, Wilmette, IL, United States; Elizabeth R. Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Quality care provided for pediatric acute agitation in the emergency department (ED) should be safe and patient-centered. Multidisciplinary stakeholders previously reached consensus on the importance of 20 proposed quality measures for pediatric acute agitation management. According to the National Quality Forum, a quality measure should also be feasible to obtain and demonstrate performance variation across populations, indicating an opportunity exists for improvement.

Objective: To assess 20 stakeholder-prioritized quality measures for pediatric ED agitation management in terms of (1) feasibility to obtain and (2) performance variation across patient populations and hospitals.

Design/Methods: Twenty quality measures for pediatric agitation management were assessed for feasibility to obtain from readily available data sources and performance variation at a tertiary children’s hospital and a community hospital. We assessed ED visits by children 5 to 17 years old who presented for a mental health condition, received medication for agitation, or received physical restraints from 7/1/20 to 6/30/21. We used multivariate models to examine measure performance by patient and hospital characteristics.

Results: We identified 2115 mental health ED visits, 143 visits with medication for agitation, and 27 visits with physical restraints. Eleven of the 20 quality measures were feasible to obtain from the electronic health record or family experience surveys. Quality measure performance varied by patient characteristics and across hospitals (Table). There was low overall performance on involvement of child life (3.5%). Males were more likely than females to receive medication for agitation (adjusted odds ratio [aOR] 2.17, 95% CI 1.47-3.19) and physical restraints (aOR 2.59, 95% CI 1.15-5.80). Children with autism spectrum disorder were more likely to be placed in a safe room, receive medications and physical restraints, and have individualized plans to prevent re-escalation (P < 0.01 for each). Compared to the children’s hospital, children at the community hospital were less likely to be placed in a safe room, more likely to have timely vital signs completed, and had a faster time from medication order to administration (P < 0.05 for each).Conclusion(s): Eleven quality measures for pediatric agitation management were feasible to evaluate, with variation in performance across patient characteristics and hospitals, highlighting opportunities for improvement. These measures may be useful for assessing and improving quality of care for pediatric ED agitation management.
Quality Measure Performance Overall and Variation by Patient Characteristics and Hospital