Using Quality Improvement Science to Create a Navigator in the Electronic Health Record for the Consolidation of Patient Information Surrounding Pediatric End-of-Life Care

Abstract

BackgroundIt is important to document the domains surrounding end-of-life (EOL) care in the electronic health record (EHR). No pediatric navigator exists for these purposes. MeasuresMedical charts were reviewed for documentation surrounding code status and care at the time of death from January 2017 to June 2019. InterventionCreation of a navigator in the EHR to consolidate advance care planning documents, code status orders and notes and EOL flowsheets. OutcomesAfter implementing the navigator, 96% code status changes had supporting documentation, an increase of 35%. The percentage of deaths supported by a psychosocial team (social worker, chaplain and certified child life specialist) increased by 25%. Post-mortem documentation became electronic. Patient level metrics began to be electronically collected. Conclusions/Lessons LearnedLittle has been published regarding use of the EHR to consolidate EOL documentation in pediatrics. Development of a systematic approach to documentation is critical to providing EOL care and standardizing care delivered.