596 - Implementation of a Care Coordination Document Across Clinical Environments within the Electronic Health Record at an Integrated Healthcare System for Pediatric Patients with Complex Medical Needs

Poster Number: 596
Publication Number: 596.403

RAGHUVEER PUTTAGUNTA, Geisinger Commonwealth School of Medicine, Mcallen, TX, United States; Thomas W. Davis, Janet Weis Children's Hospital at Geisinger, Danville, PA, United States

Background: Care coordination for children with complex medical needs is often complicated and delayed due to the difficulty of providers finding up to date information timely. This is compounded by specialty workflow differences in the Electronic Health Record (EHR).

Objective: To evaluate a cross-institutional care plan across clinical settings aimed to address emergency care, patient background, indwelling device details, and key care contacts including medical supply and home health agencies.

Design/Methods: Based on an exploratory study of how emergency care plan were documented across 10 pediatric specialties for patients across an integrated healthcare system and technical limitations available within the institutional EHR, the care coordination note (CCN) tool within the Epic EHR with a standardized template was used to provide an area of central documentation for patients cared for by the Pediatric Complex Care and Cystic Fibrosis clinical groups. The care coordination note was then incorporated into common areas of the EHR for each specialty (eg Emergency Medicine, Hospitalists, Neurology). Using pre/post analysis, we compared accuracy and time to orders. Quantity of note changes and inclusion of the information in other documentation was also tracked.  

Results: A total of 238 patients had an available CCN from 4/1/2020 to 12/31/2021. The CCN was copied into other documentation over 103 times, and was updated an average of 2.7 times (SD 1.9, range 1-23), within the 21-month study period. Though the CCN was predominately updated by the outpatient primary care team, outpatient subspecialities and care managers also updated information. Observation workflow studies found that outpatient providers often used chart search, scanned documents, and last notes to find key information, and intermittently used Epic Snapshot, while Emergency Medicine and Inpatient providers were more likely to use problem list and discharge summaries to find key information. The CCN was placed prominently within the Epic Snapshot, Problem List, and Triage Activity tabs with targeted education provided to providers. A total of 118 pre- and 64 post-CCN implementation acute inpatient encounters were evaluated which showed improved accuracy of antibiotics ordered (p < 0.05) and a trend to decreased time to ordering recommended antibiotics (p = 0.064).Conclusion(s): The care coordination note is a concise tool to help clinicians quickly gather important cross continuum information on a patient’s conditions that can improve clinical care in a complex healthcare environment, but must be tailored to unique specialty workflows.