Abstracts

Rationale: Application of Quality Improvement (QI) principles has been demonstrated to decrease morbidity, mortality and costs in a variety of health care settings. The QI process requires: identification of process to be improved, agreement on measures, implementation of a remedy and assessment of the remedy on the process. In this report we describe our initial progress on implementing QI measures for children who presented to a pediatric neurology clinic with suspected seizures.Methods: This study was performed at the Alberta Children’s Hospital following a waiver from the University of Calgary Regional Ethics Board obtained after review by the group in charge of ethics for QI projects. The Comprehensive Children’s Epilepsy Centre Workgroup (CCECWG) at Alberta Children’s Hospital (composed of physicians, nurses, dietitians, psychologist, neuropsychologist, pharmacist, EEG technologists and research staff) meets 2-3 hours per month to develop outcome measure and pathways of care. Outcome measures derived from this process and other seizure related information were instantiated in Sunrise Clinical Manager v6.1 (SCM) clinical information system using a clinic specific Electronic Health Record (EHR). The EHR fields were populated by the nurses and physicians at the time of care. Selected SCM tables were extracted daily (00:00:00) to an Oracle 11g database and the EHR reconstituted in a clinic specific schema. Selected fields (patient and seizure characteristics, outcome measures) were then electronically visualized in dashboard format using Tableau v8.2 software (Seattle, WA). The entire processes of data Extraction, Transformation & Load (ETL) from source to visualization were completely automated providing near time access (within 24 hrs) to previous days records.Results: The CCECWG derived the following outcome measures: seizure frequency, treatment related adverse effects, emergency department & hospital admissions, and cognitive/QOL screening. All but the cognitive/QOL measures were implanted in the EHR epilepsy note that was started in Pediatric Neurology Clinic in December 2014. To 31 May 2015 there have been 723 notes entered on 625 patients (343 males & 282 females). Of these visits 166 were new consultations and 485 were return visits. Seizure frequency was entered in 82.7% of patients. Treatment related adverse effects categorized as ‘absent’, ‘present but not significant enough to change medication’ and ‘present & change required’ were entered in 16.3% of patients. 16.8% of patients were seen in the Emergency Department and 8.9% were admitted to the hospital. All data was available in dashboard format to the care providers within 24 hours of the office visit.Conclusions: These results indicate: 1) It is possible to determine clinically meaningful outcomes measures for pediatric epilepsy by a consensus process 2) these measures can be incorporated into an EHR and 3) the measures can be visualized & used to guide therapy within 24 hours of entry. Funding source: Alberta Children’s Hospital Foundation