Measures
Patient data consisted of demographics: age, respiratory diagnoses,
comorbidities, admissions in the year preceding the decision, presence
of outside services or involvement with governmental agencies,
tracheostomy outcome, and mortality data. Length of the stay reflected
time continuously spent in an inpatient setting, including those days
that patients transiently spent at an outside institution for cardiac
procedures not offered at the small children’s hospital.
Health care professionals that collaborated in the care of a patient and
documented that interaction in the EMR comprised the ecosystem of health
care providers. This ecosystem was divided into three broad categories:
1) physician-led medical services; 2) physician-led surgical services;
3) non-physician led services. Timing of palliative care and pulmonology
consults relative to admission and to tracheostomy placement were noted.
Documentation of answers to the 12 key questions comprised the measures
of information. If an answer to a question was clearly found at least
once in any location in the medical record, the answer was coded as
“present.” 2 of the 12 questions included in the protocol were removed
from chart review. One question was eliminated because investigators
could find no places in the EMR where health professionals involved in a
child’s care were routinely listed. A second question, regarding “any
other concerns,” was removed since its answer hinged upon consolidation
in one location of the answers to the other 11 questions, a circumstance
that almost never occurred. If the answer to any of the remaining 10
questions could not be found, or could only be inferred, the answer was
coded as “absent.”