Low Value Care No Hiding In The EMR Dr Joanna Lawrence , - PowerPoint PPT Presentation

Low Value Care No Hiding In The EMR Dr Joanna Lawrence , Paediatrician, EMR trainer On behalf of; Lauren Andrew (EMR Optimisation Manager) Harriet Hiscock (HSRU), Alice Voskoboynik (EMR reporting) , Ahuva Segal (EMR research), Emma Weiss, Suzi Riess (Paediatricians) and others

 ‘An important conversation about unnecessary tests, treatments and procedures’

 Oral antibiotics for fever  Chest xrays in asthma Top 5  Chest xrays and medications in bronchiolitis low value  Acid suppression in gastro-oesophageal reflux practices in  Abdominal xray in nonspecific abdo pain Paediatrics

 Oral antibiotics for fever  Chest xrays in asthma  Chest xrays and medications in bronchiolitis Evolve Criteria  Acid suppression in gastro-oesophageal reflux (RACP, division  Abdominal xray in nonspecific abdo pain of Paediatrics)

5 times more likely to receive antibiotics

 All patients aged 1-12 months presenting to ED  with Principle Problem of bronchiolitis  between April 2016 – June 2018  excluded those going to ICU What are we  3781 encounters Discharged 3.5% doing? from ED Discharged 24.5%  11.3% had a CXR from ward

Indications; - ICU admission/ review (severe) (excluded) - NGT placement 16% - underlying cardiac concern 5% - pneumothorax/ foreign body 4% - ?consolidation/ collapse 73% Is 11.3% reasonable?

BOTTOM LINE  11.3% of all children with ED diagnosis of bronchiolitis receive an CXR Bottom Line  70% of these made no difference to patient management and may have increased antibiotic use  ~1200 CXRs per year that could be avoided  $58,000 per year

 We know  we do have a problem  the size of the problem  where the problem is occurring What have we  what is contributing to the problem learnt

 Oral antibiotics for fever  Chest xrays in asthma  Chest xrays and medications in bronchiolitis Top 5 Low  Acid suppression in gastro-oesophageal reflux Value Practices  Abdominal xray in nonspecific abdo pain in Paediatrics

1318% What’s the 1995-2006 Issue? 2 nd highest PBS cost More risks than initially appreciated Accepted indications……..

All RCH scripts for PPI/ H2R antagonist between August – September 2016 What are we Excluded ICU/ protocols specifying need for acid suppression doing? 303 prescriptions in 232 patients

 238 of 303 prescriptions were NOT indicated  78.5% of all scripts were not indicated Who  $15,493 per year of prescriptions Where  Associated with consultant provider OR 2.69 inpatient status OR 2.35 PEJ/ PEG OR 5.5 Target

 Oral antibiotics for fever  Chest xrays in asthma  Chest xrays and medications in bronchiolitis Top 5 Low  Acid suppression in gastro-oesophageal reflux Value practices  Abdominal xray in nonspecific abdo pain in Paediatrics

Benchmark; CXR is indicated in ~10% of children with asthma All children aged 1- 18yo given a principal problem of ‘asthma’ in the emergency department between April 2016 to June 2018. Asthma 3305 children - 10.5% of patients had a CXR performed. Key finding:

 Oral antibiotics for fever  Chest xrays in asthma  Chest xrays and medications in bronchiolitis Top 5 Low  Acid suppression in gastro-oesophageal reflux Value Practices  Abdominal xray in nonspecific abdo pain in Paediatrics

 All patients aged 1 month to 18 years with ‘reason for attendance’ in ED or ‘hospital problem’ for inpatient admissions from July -Nov 2017  2117 encounters  98 had AXR (4.7%)

x Iron Studies 630/ month Ferritin ~400/ month $14.30 $7.40

 Loads of data  Big data sets to allow us to measure practice, Key Learnings identify problem areas and design targeted interventions  It’s only as good as the data we put in