Leveraging the Electronic Medical Record to Increase Distribution of Low Literacy Asthma Education in the Emergency Department

OBJECTIVE: Though low literacy asthma education is effective at reducing emergency department (ED) use, few interventions are administered in the ED. The aim was to increase the number of parents of children with asthma receiving education in the ED to 50% receiving written and 30% receiving video education over 12 months. METHODS: Using quality improvement methods, the team planned interventions including improvement of nursing work-flow and availability of written and video education. Nurse champions performed peer-to-peer education regarding educational materials and health literacy-focused communication. An asthma education order opening the nursing flowsheet, which linked to written and video materials and documentation was created. The order was placed in highly used ED asthma order sets. The percent of parents receiving written or video education was followed on statistical process control charts. Balancing measures included: ED length of stay, discharge length, 30 day ED return visits, and 365 day return visits with hospitalization. RESULTS: The mean number of parents receiving written education at baseline was 28% and improved to 52%. Special cause variation was noted after order roll-out. Video education increased from a baseline of 0% of parents receiving to 32% with special cause variation after order roll-out. No special cause was noted in balancing measures. Revisits with hospitalization within 365 days showed a decreasing trend after order roll-out. CONCLUSIONS: Implementation of workflow improvement, education, and the addition of a functional education order in an existing order set led to a meaningful improvement in distribution of a low literacy asthma education intervention.

Automated summary

By improving workflow in the emergency department, providing written and video education, and adding a functional education order, there was a significant increase in the percentage of parents of children with asthma receiving education, leading to a decrease in 30-day return visits and hospitalizations within 365 days.