Perceived Frequency and Impact of Missing Information at Pediatric Emergency and General Ambulatory Encounters

Lisa M. Schilling; Lori A. Crane; Allison Kempe; Deborah S. Main; Marion R. Sills; Arthur J. Davidson

doi:10.4338/ACI-2010-04-RA-0022

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2010; 01(03): 318-330
DOI: 10.4338/ACI-2010-04-RA-0022

Research Article

Schattauer GmbH

Perceived Frequency and Impact of Missing Information at Pediatric Emergency and General Ambulatory Encounters

Authors

Lisa M. Schilling

¹University of Colorado Denver School of Medicine, Department of Medicine
Lori A. Crane

²University of Colorado Denver School of Public Health, Department of Preventive Medicine and Biometrics
Allison Kempe

³Department of Pediatrics, University of Colorado Denver School of Medicine, and the Children‘s Outcomes Research Program, The Children‘s Hospital
Deborah S. Main

⁴Department of Family Medicine, University of Colorado Denver School of Medicine and the Colorado Health Outcomes Program
Marion R. Sills

⁵Department of Pediatrics, Department of Preventive Medicine and Biometrics, University of Colorado Denver School of Medicine, The Children’s Hospital
Arthur J. Davidson

⁶Denver Public Health, Denver Health and the University of Colorado Denver School of Medicine

Abstract

Summary

Objective: To document the perceived frequency, type, and impact of unavailable (“missing”) clinical information during pediatric emergency and general ambulatory encounters.

Methods: This prospective cohort set in the Emergency Department and General Ambulatory Pediatric Clinic at The Children’s Hospital, Aurora, CO, assessed pediatric attending physician perceptions regarding missing information at emergency and general ambulatory encounters. The main outcome measures were the frequency of perceived missing information; its presumed location; time spent seeking; and the perceived effects on resource utilization and overall quality of care.

Results: Pediatric physicians reported missing information for 2% of emergency and 22% of general ambulatory encounters. Types of missing information at general ambulatory visits included immunization (34% of types), general past medical (29%), and disease or visit specific histories (13%). Missing information at ambulatory visits was sought 20% of the time, obtained 4% of the time, and rated “somewhat or very important for today’s care” (73% of the time) and “somewhat or very important for future care” (84% of the time). For encounters with unattained missing information, physicians reported adverse affects on the efficiency of the visit (64%), physician’s confidence in care (33%), patient/family satisfaction (17%), disposition decisions (8%), and recommended additional treatment (38%), laboratory studies (16%), and imaging (12%). For 57% of encounters with missing information, physicians perceived an adverse effect on overall quality of care. Missing information was associated with not having a primary care visit at TCH within 12 months of the encounter, (OR 2.8; 95% CI, 1.7, 4.5).

Conclusion: Pediatric physicians more commonly experience missing information at general ambulatory visits than emergency visits and report that missing information adversely impacts quality, efficiency, their confidence in care, patient and family satisfaction, and leads to potentially redundant resource utilization.

Keywords

Medical records - primary care - health information exchange

Full Text

References

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