ESPE2021 ePoster Category 1 Growth B (10 abstracts)
Facilitating Telehealth In A Tertiary Paediatric Endocrine Service: A Quality Improvement Initiative To Reduce The Discrepancy Between Parent-reported And Auxologist Height Measurements
Sinéad M McGlacken-Byrne 1 , Ashley Alexander 1 , Sally Tollerfield 1 , Abigail Atterbury 1 , Hannah Antell 1 , Victor Mead 1 , Antonia Dastamani 1 , Catherine Peters 1 , Hoong Wei Gan 1 , Rakesh Amin 1 , Mehul T Dattani 1,2 , Steve Hoskins 1 & Harshini Katugampola 1
1Department of Paediatric Endocrinology and Diabetes, Great Ormond Street Hospital, London, United Kingdom; 2Genetics & Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
Background: The COVID-19 crisis required paediatric endocrinologists to rapidly adopt telehealth into their clinical practice. Accurate auxology is a cornerstone of paediatric endocrinology care and is needed to monitor growth and guide medication changes. Remote consultations depend upon parent-reported measurements. However, home height measurements are often inaccurate.
Aim: We designed a quality improvement study with the aim of reducing the mean percentage difference between auxologist and parent-reported home measurements from 2.6% to 0.5% over a 2-month period.
Methods: Patients between the ages of 2 and 18 years attending face-to-face appointments at paediatric endocrinology clinics over a 2-month period (August-October 2020) were included. We compared the mean percentage difference between parent-reported height measurements taken prior to clinic to the “gold standard” height measurements taken on the day of clinic review by a single paediatric auxologist. We conducted a baseline audit over a two-week period which demonstrated that the mean percentage difference between parent-reported and auxologist height measurements was 2.6% (SD 4.1), with the proportion of parents providing home height measurements being 57.4%. Three Plan-Do-Study-Act (PDSA) cycles followed. The mean percentage difference between home and auxologist height measurements was tracked prospectively on a run chart. Data were also collected on the proportion of parents providing home height measurements.
Results: A total of 59 children were included (61.0% male, n = 36) with a mean age of 12.1 years (SD 3.8). During the first PDSA cycle, parents were provided with verbal reminders and brief instructions on how to measure their child a week prior to clinic review. The second cycle focused on ensuring all families were registered on the patient communication portal of the hospital’s electronic healthcare record system. Parents were then sent an electronic reminder via the portal two days before their clinic review. Parents were also called by a clinical team member to discuss the home height measurement process in detail, facilitated by departmental guidelines. The third PDSA cycle focused on sustainability; parent reminders and home height measurements instructions were embedded into standard pre-visit electronic hospital communications. Mean percentage difference between home and auxologist height measurements was reduced to 0.4% (SD 0.4), with 91.6% of parents providing home height measurements.
Conclusions: Change interventions focusing on simple reminders and parental empowerment resulted in improved reliability of parent-reported height measurements. This will facilitate clinical care decisions during teleconsultations, which are likely to remain a part of routine paediatric endocrinology practice going forward.
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