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J Am Med Inform Assoc. 2019 Mar 19. pii: ocy184. doi: 10.1093/jamia/ocy184. [Epub ahead of print]

Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.

Author information

1
Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
2
Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
3
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
4
Department of Operations Integration, Johns Hopkins Hospital, Baltimore, Maryland, USA.
5
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
6
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
7
Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA.

Abstract

OBJECTIVES:

The study sought to identify collaborative electronic health record (EHR) usage patterns for pediatric trauma patients and determine how the usage patterns are related to patient outcomes.

MATERIALS AND METHODS:

A process mining-based network analysis was applied to EHR metadata and trauma registry data for a cohort of pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The EHR metadata were processed into an event log that was segmented based on gaps in the temporal continuity of events. A usage pattern was constructed for each encounter by creating edges among functional roles that were captured within the same event log segment. These patterns were classified into groups using graph kernel and unsupervised spectral clustering methods. Demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS) of the groups were compared.

RESULTS:

Three distinct usage patterns that differed by network density were discovered: fully connected (clique), partially connected, and disconnected (isolated). Compared with the fully connected pattern, encounters with the partially connected pattern had an adjusted median ED LOS that was significantly longer (242.6 [95% confidence interval, 236.9-246.0] minutes vs 295.2 [95% confidence, 289.2-297.8] minutes), more frequently seen among day shift and weekday arrivals, and involved otolaryngology, ophthalmology services, and child life specialists.

DISCUSSION:

The clique-like usage pattern was associated with decreased ED LOS for the study cohort, suggesting greater degree of collaboration resulted in shorter stay.

CONCLUSIONS:

Further investigation to understand and address causal factors can lead to improvement in multidisciplinary collaboration.

KEYWORDS:

electronic health record; multidisciplinary collaboration; network analysis; pediatric trauma; process mining

PMID:
30889243
DOI:
10.1093/jamia/ocy184

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