Parent and Provider Impressions of Emergency Planning for CSHCN Midwest Emergency Medical Services f

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Parent and Provider Impressions of Emergency
Planning for CSHCN Midwest Emergency Medical
Services for Children Information System
(MEMSCIS.com)

• Lee A. Pyles, MD, Kathy Jamrozek, RN, Jessica
  C. Hannan, RN, Margaret Scheid, RN, MSN,
  Claudia I. Hines, RN, MSN
• University of Minnesota Childrens Hospital and
  Departments of Pediatrics and Emergency Medicine,
  
• Emergency Medical Services for Children Resource
  Center of Minnesota, Childrens Hospitals and
  Clinics of Minnesota

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Disclosures

• No conflicts of interest
• No investigational drugs or devices
• Research and Presentation supported by US DHHS
  MCHB Grants H34MCC0091 and H34MC02544 MCHB EMS
  for Children Program.

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Introduction

• Emergency Information Form is a paper summary of
  CSHCN clinical history
• Demographics
• Diagnoses
• Procedures
• Medications
• Precautions
• Suggested Treatments
• Baseline VS and Physical Exam

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Introduction EIF / MEMSCIS Data Elements

• Emergency Information Form is a paper summary of
  CSHCN clinical history
• Demographics
• Diagnoses
• Procedures
• Medications
• Precautions
• Suggested Treatments
• Baseline VS and Physical Exam
• American Academy of Pediatrics, Committee on
  Pediatric Emergency Medicine, Preparedness for
  Children with Special Health Care Needs.
  Pediatrics 1999104(4)E53.

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MEMSCIS

• Midwest Emergency Medical Services for Children
  Information System www.memscis.com
• Web-linked database to store Emergency
  Information Forms
• Pyles, LA, Hines, C, Patock, M, et al.
  Development of a Web-based Database to Manage
  American College of Emergency Physicians/
  American Academy of Pediatrics Emergency
  Information Forms. Academic Emergency Medicine
  Vol 12 (3) 1-5. March 2005.

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EHR ? PHR

• MEMSCIS is a hybrid electronic health record for
  providers and personal health record for parents
  of Children with Special Health Care Needs
• Unique Features
• Advice Section
• Icon system of data attribution

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Study

• 170 (94 study and 76 control) children enrolled
  in IRB-approved prospective randomized controlled
  trial from 9/26/02 to 9/11/04 and followed to
  2/28/05.
• Inclusion/Exclusion
• Children under age two with significant cardiac
  disease
• No ASD device, non-neonatal PS dilation
• No trachs, vents

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Survey

• Parents surveyed on yearly basis
• Use of MEMSCIS
• Comfort with Emergency Situation
• Perception of Provider Comfort
• Ed physician surveyed after ED visit
• Surveys graded with yes/no responses and 5 point
  Likert Scale to evaluate responses to survey
  questions
• Content validity reviewed with National Emergency
  Medical Services for Children Data Analysis
  Resource Center (NEDARC)

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Results

• Prior to enrollment in the study, 26 of 105
  parents (25) reported that they kept a written
  health history for their child
• 91 of parents opted-in for Break-the-Glass
  access
• 25 of parents performed updates
• 70 of updates by study nurses
• 189 ED visits (0.47 ED visits / pt / year)
• 101 Study pt
• 88 control pt

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Parent Survey Comfort Level for Emergency Care
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Parent Assessment of Comfort of Hospital
Providers
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Parent Survey ED Provider Comfort
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Hospital Provider Comfort Impression Improvement
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Parent Assessment of Discomfort of Providers
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Parent Survey Prehospital Provider Comfort Level
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Parent Survey Prehospital Provider Comfort Level
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ED Physician Survey
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Summary

• Survey reliability was supported by lack of
  change in pre-post responses in control subjects
• Families who had an EIF reported improved comfort
  for emergencies
• Families perceived that hospital providers showed
  an improved comfort level when it was learned
  that the CSHCN had an EIF

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Summary II

• Families remained neutral when questions asked
  for a negative response questions
• Families described an improvement of their
  perception of ED provider comfort over the course
  of the study, if the family had been a study
  participant but especially if family had used the
  EIF.

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Summary III

• Families described an improvement of their
  perception of pre-hospital provider comfort over
  the course of the study, if the family had been a
  study participant.

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Conclusions

• The MEMSCIS program was associated with
  development of a favorable impression of families
  for emergency providers.
• ED visit improved family impression only if the
  EIF was used.
• Providers responded favorably to the EIF when
  used.