O2134: Pediatric Emergency Department Burn Discharge and Clinic Readiness: A Quality Improvement Project

Purpose/Objectives: Pediatric emergency department visits for burns have been shown to have wide variation in discharge criteria and follow up practices. The shift to outpatient care for many pediatric burn injuries has placed a larger responsibility on caregivers for wound care and follow-up planning. Non-adherence to burn care and follow up appointments can lead to negative emotional and physical health outcomes. In this single center quality improvement project, we aimed to improve the percentage of pediatric burn patients discharged from the emergency department with the correct instruction packet, as well as the percentage of qualifying patients prescribed oxycodone at the correct dose for premedication for their initial clinic appointment.

Design/Methods: A multi-disciplinary team investigated failure modes, developed a key driver diagram, and designed interventions to improve discharge planning and oxycodone prescribing practices. Interventions included printed burn discharge pamphlets, addition of burn plan discharge prescriptions, enhanced e-prescribing access for providers, updated custom instructions, linked ICD-10 codes to proper discharge materials, removal of out-of-date instructions from the EHR, targeted monthly provider feedback, and multiple trainee education sessions. Monthly data was tracked using statistical process control charts.

Results: At baseline, 46% of patients were receiving the correct discharge packet; following interventions, we observed a center line shift to 63% with sustained improvement. Seventy-two percent of qualifying patients were receiving oxycodone for premedication before clinic follow up at baseline. There was no noted baseline shift during the study time frame. For those patients who did receive an oxycodone prescription, 91% of the oxycodone doses were correct for weight at baseline. Following interventions during the study period, we observed a sustained baseline shift to 100% accurate dosing for those patients prescribed oxycodone.

Conclusion/Discussion: Following multiple, diverse targeted interventions, our multidisciplinary team saw a sustained improvement in use of a custom burn discharge instruction packet as well as correct oxycodone dosing for pain control with dressing changes. Both parental education and pain control with dressing changes are important factors in adherence to outpatient care which has been shown to optimize health outcomes. Implementing protocols to improve outpatient burn care could also be an important cost-saving measure, by avoiding re-admissions and return visits to the Emergency Department. Future research could examine the impact of accurate discharge instructions and oxycodone prescriptions on the timeliness of outpatient appointment scheduling, and pain scores.