Using Quality Improvement Science to Create a Navigator in the Electronic Health Record for the Consolidation of Patient Information Surrounding Pediatric End-of-Life Care
code status; documentation; electronic health record; end of life care; models of palliative care delivery; pediatrics
BACKGROUND: It is important to document the domains surrounding end-of-life (EOL) care in the electronic health record (EHR). No pediatric navigator exists for these purposes. MEASURES: Medical charts were reviewed for documentation surrounding code status and care at the time of death from January 2017 to June 2019. INTERVENTION: Creation of a navigator in the EHR to consolidate advance care planning documents, code status orders and notes and EOL flowsheets. OUTCOMES: After implementing the navigator, 96% code status changes had supporting documentation, an increase of 35%. The percentage of deaths supported by a psychosocial team (social worker, chaplain and certified child life specialist) increased by 25%. Post-mortem documentation became electronic. Patient level metrics began to be electronically collected. CONCLUSIONS/LESSONS LEARNED: Little has been published regarding use of the EHR to consolidate EOL documentation in pediatrics. Development of a systematic approach to documentation is critical to providing EOL care and standardizing care delivered.
Casas J; Jeppesen A; Peters L; Schuelke T; Magdoza NRK; Hesselgrave J; Loftis L
Journal of Pain and Symptom Management
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpainsymman.2021.04.006" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2021.04.006</a>
Improving health care for adult survivors of childhood cancer: recommendations from a delphi panel of health policy experts
Humans; United States; Adult; Health Policy; Health Services Research; Quality of Health Care; Delphi Technique; Survivors; Non-U.S. Gov't; Research Support; Neoplasms
OBJECTIVES: To identify barriers to, models of care for, and initiatives to improve health care of adult survivors of childhood cancer. METHODS: Seventeen health care policy experts were asked to respond to the three objectives through a three-iterative Delphi process. RESULTS: Key barriers identified were that primary care physicians are unfamiliar with the health problems of survivors and survivors are often unaware of their risks. The recommended model of care would incorporate the chronic disease management model. Highest priority initiatives recommended were targeted education of primary care physicians and survivors, development and evaluation of standards of survivorship care, and a national web-based information center. CONCLUSIONS: The insights and recommendations of the panel provide a foundation intended to improve health care of cancer survivors.
2004
Mertens AC; Cotter KL; Foster BM; Zebrack BJ; Hudson MM; Eshelman D; Loftis L; Sozio M; Oeffinger KC
Health Policy (amsterdam, Netherlands)
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.healthpol.2003.12.008" target="_blank" rel="noreferrer">10.1016/j.healthpol.2003.12.008</a>