Development, implementation, and evaluation of structured Performa in the initial assessment of sick children at the emergency department: A third level Kirkpatrick’s evaluation model

Abstract

Background & Objective: At emergency department (ED) at different point of time different teams are involved in management of patients as per their posting/duty roster. So, a robust system should be in place to avoid major mishaps. The current study was an attempt to improve pediatric care at our Emergency Department through third-level Kirkpatrick’s evaluation model after training of pediatric resident doctors to use newly developed structured proforma while doing initial assessment of sick children at ED. Materials & Methods: This Quasi-experimental study included all departmental pediatric resident doctors and as per sample size calculation, 36 (pre-intervention) and 36 (post-intervention) computer-generated random selection records were reviewed from the total of serially arranged admissions of pediatric patients. The intervention was the implementation of a Structured proforma, and training of all departmental residents. All raters scored the records of patients on 47 & 51 items of documentation pre-and post-intervention periods respectively on a scale 0-2, 0 meaning ‘no mention’, 1-incomplete/improper mention and 2-complete/proper mention. Mean, standard deviation (SD) of scores were calculated item-wise, raters-wise and overall. Bland Altman analysis was done to find agreement in scoring among raters both in pre-and post-intervention. Results: The mean (SD) and percentage of mean score were 32.93 (4.50) and 35.03% before intervention whereas 89.64 (4.35) and 87.88% post-intervention. This indicated 53.5% improvement post-intervention. Bland Altman analysis found good agreement post-intervention. Conclusion: The introduction of Educational tool along with the training of pediatric resident doctors to implement it, has improved documentation process significantly.