Audit and Feedback on Pediatric Emergency Department Performance Measures: A Stepped-Wedge Trial

James M. Chamberlain, Departments of Pediatrics and Emergency Medicine, Division of Emergency Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Norma-Jean E. Simon, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Lalit Bajaj, Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
Evaline Alessandrini, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Robert W. Grundmeier, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Marc Gorelick, Children's Research Institute, Children's Minnesota, Minneapolis Minnesota.
Blake Nielsen, Data Coordinating Center, University of Utah, Salt Lake City, Utah.
Cody S. Olsen, Data Coordinating Center, University of Utah, Salt Lake City, Utah.
Sriram Ramgopal, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Joseph J. Zorc, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Cara Elsholz, Data Coordinating Center, University of Utah, Salt Lake City, Utah.
Lawrence J. Cook, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Elizabeth R. Alpern, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Document Type

Journal Article

Publication Date

11-1-2025

Journal

Hospital pediatrics

Volume

15

Issue

11

DOI

10.1542/hpeds.2025-008440

Abstract

BACKGROUND: Audit and feedback can prompt clinician improvements. The benefit of this approach in pediatric emergency department (PED) systems is unclear. We evaluated the feasibility of a multisite, monthly automated report card and its effect on quality performance within and across emergency department sites. METHODS: We conducted a stepped-wedge randomized trial across 4 academic and 3 affiliated PEDs in the Pediatric Emergency Care Applied Research Network between January 2013 and April 2016. The intervention consisted of monthly site-level quality performance reports featuring bar charts with benchmarks, visit counts, and 12-month trends derived from electronic health record (EHR) data. Measures included initial care documentation (weight, vital signs) and throughput (time to clinician, time to imaging results, left without being seen rate, and length of stay). We evaluated the intervention's effect on performance measures and slope changes at implementation. RESULTS: We included 1 426 109 encounters (864 940 during the preintervention period, 561 169 during the postintervention period). We observed improved performance for 4 measures: weight for all visits (+0.2%), documentation of all vitals (+10.1%), time to vitals documentation (-12.0%), and time to plain film radiology report (-3.5%). We observed a decline in performance measures related to throughput, with increases in time to clinician, mean length of stay, and the proportion of patients leaving without being seen. CONCLUSIONS: We demonstrate the feasibility of providing quality performance report cards to hospital leaders using EHR data. We found mixed results in terms of the effectiveness of improving site-level metrics. Future efforts may facilitate further refinement of these interventions prior to dissemination.

Department

Pediatrics

Link to Full Text

Share

COinS