Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Pediatr Blood Cancer. 2021 Feb;68(2):e28831. doi: 10.1002/pbc.28831. Epub 2020 Nov 30.
Although annual transcranial Doppler (TCD) screening is recommended for children with sickle cell anemia (SCA), compliance is low and variable. Our objective was to utilize an electronic health record (EHR)-based registry to improve TCD adherence among children with SCA, 2-16 years of age, at our institution.
We developed an in-EPIC real time registry for children with sickle cell disease in year 2016. Since end of year 2016, we have been extracting data quarterly to examine TCD rates and share the list of children who have not received a TCD screen in the past 18 months with the clinical team. The registry also includes a TCD risk score to enhance point of care. We also added Child Life support to increase TCD compliance among children <7 years. Control charts are used to examine TCD rates.
At baseline, prior to and start of quarterly data audit and feedback, 63% of children received the recommended annual TCD screen. TCD rates steadily increased to 80% by the third quarter of 2017. We observed a dip in TCD rates, driven by failure of screening young children. Since the initiation of Child Life support for children <7 years, we have sustained TCD screen rates >70%. Overall, our data meet criteria for special cause variation, indicating improvement in TCD rates since 2015.
Regular tracking and identification of patients overdue for a TCD screen using an EHR-based registry resulted in sustained improvement in TCD screening rates. Involvement of Child Life support further improved TCD rates.
虽然推荐对镰状细胞贫血症（SCA）患儿进行年度经颅多普勒（TCD）筛查，但患者的依从性高低不一。我们的目标是利用电子病历（EHR）中的登记系统，提高我院 2-16 岁 SCA 患儿的 TCD 检查依从性。
我们于 2016 年为镰状细胞病患儿开发了一个 EPIC 实时登记系统。自 2016 年年末以来，我们每季度提取数据，以检查 TCD 率，并与临床团队共享过去 18 个月未接受 TCD 筛查的患儿名单。该登记系统还包括 TCD 风险评分，以增强即时护理。我们还增加了儿童生活支持，以提高 7 岁以下儿童的 TCD 依从性。控制图用于检查 TCD 率。
在基线时，在季度数据审核和反馈之前和开始时，有 63%的患儿接受了推荐的年度 TCD 筛查。到 2017 年第三季度，TCD 率稳步上升至 80%。我们观察到 TCD 率下降，原因是未能对年幼的儿童进行筛查。自为 7 岁以下儿童提供儿童生活支持以来，我们的 TCD 筛查率一直保持在 70%以上。总体而言，我们的数据符合特殊原因变异的标准，表明自 2015 年以来 TCD 率有所提高。
使用基于 EHR 的登记系统定期跟踪和识别需要进行 TCD 筛查的患者，可持续提高 TCD 筛查率。儿童生活支持的参与进一步提高了 TCD 率。
