815 - Improving the Rate of Emergency Department Physician Pre-Procedure Time-Out Documentation for Deep Sedation and Cutaneous Abscess Incision and Drainage
Pediatric Emergency Physician Children's Mercy Kansas City Children's Mercy Kansas City Kansas City, Missouri, United States
Background: The pre-procedure time-out, an important safety measure to verify patient identity and accuracy of a planned procedure, and Joint Commission requirement, is not documented consistently by physicians in our emergency department (ED). Deep sedation and cutaneous abscess incision and drainage (I&D) are two high-risk procedures performed in the ED, supporting the use of a time-out in this setting. Between June 2018 and May 2019, a pre-procedure time-out was documented in the physician procedure note of the electronic medical record (EMR) for 75% of deep sedations, and 94% of I&Ds.
Objective: We aimed to improve ED physician pre-procedure time-out documentation for deep sedation (ketamine and/or propofol) from 75% to 90%, and I&D from 94% to 98% by July 2020.
Design/Methods: Our ED is part of a free-standing, tertiary children’s hospital, comprised of two separate locations across two states, with a combined annual volume of 125,000 visits. We analyzed one year of baseline data for deep sedations and I&Ds performed in both locations, followed by weekly reports from November 2019 to July 2020. We provided education to the physicians regarding the history and importance of the pre-procedure time-out, monthly reminders and updates, as well as individualized feedback for deficient documentation. We optimized EMR procedure notes for deep sedation and I&D, and incentivized the project with American Board of Pediatrics Maintenance of Certification (MOC) credit, as well as a financial bonus. For cases of concurrent deep sedation and I&D, we expected the time-out be documented in both of the independent procedure notes, and measured these accordingly.
Results: During the study period we averaged 100 deep sedations and 25 I&Ds per month. Physician documentation of a pre-procedure time-out improved from 75% to 100% for deep sedation, and from 94% to 99.3% for I&D. The improvements remained sustained for five months without additional intervention. All physicians were eligible for the financial bonus; 40 met MOC credit requirements. Conclusion(s): A pre-procedure time-out may reduce the likelihood of avoidable patient harm and is practical to perform in a busy ED setting.Using quality improvement methodology, we increased ED physician pre-procedure time-out documentation for deep sedation and I&D through education, feedback, and systems improvement. Future studies may quantify the effects on patient safety and examine the use of similar interventions for other ED procedures.
Authors/Institutions: Arjun Sarin, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States; Nikita Sharma, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States; Shobhit Jain, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
