Discharge documentation for febrile children in the paediatric emergency department : how can it be improved?

Abstract

BACKGROUND: A high turnover of patients is the norm at the paediatric emergency department, which inadvertently affects the documentation of patients’ encounters.

METHODS: This retrospective study involved two audit cycles, performed over six-week periods at a one-year interval, to assess discharge documentation for febrile children in the paediatric emergency department. Documentation for the following fields was assessed; diagnosis, treatment prescribed, drug doses, advice given, legibility and follow-up plan. A number of deficiencies in documentation were identified following the first cycle. Three interventions were implemented: presentation of initial audit to doctors, setting-up of a follow-up clinic for febrile children and designing a handout for carers about caring for febrile children. Chi-squared test was used, with a p-value of <0.05 considered as significant.

RESULTS: 386 and 380 children were included respectively in the first and second audit. Diagnosis was documented in 84% (n=324) and 80% (n=304) respectively (p=0.09). No significant change in documentation of the prescribed treatment was noted, 73% (n=285) versus 79.4% (n=302). However, there was a significant positive trend in documentation of actual drug doses (p<0.0001). Documentation of advice given to carers rose significantly from 11% to 48.6% (p<0.0001). A significant improvement in documentation for follow-up plan was documented, 32% (n=122) to 40% (n=153) (p=0.01). Legibility was the only parameter to show a worsening trend (p<0.0001).

CONCLUSIONS: This study looks at the effectiveness of three interventions on the level of documentation for discharge planning of febrile children from the paediatric emergency department. In spite of the marked gains, there is room for improvement.