What may seem like a simple adaptation to our technology-driven world has transformed the retrieval of critical patient information, say Yale Urology pediatric providers. They now use electronic tablets for a Yale-crafted questionnaire that better helps the team make a clear diagnosis, prepare an optimal treatment plan, and impact future research.
A Vital Questionnaire
Less is not more when it comes to unraveling the causes of lower urinary tract ailments and continence issues, especially in children. The first time a young patient with these symptoms is seen in one of the Yale Urology clinics, the family is asked to complete a robust survey. Providers explain that the document is crafted from validated voiding dysfunction questionnaires, as well as quick assessment psychiatric materials devised for voiding problems. In the 138 questions there are carefully crafted items with a specific purpose, all based on a breadth of experience and research in the field of lower urinary tract and bowel problems.
“The questions are vital in helping us and the parents treat the whole child,” says Cathy Conway, a nurse coordinator for pediatric urology. “It’s often not just about a wetting issue.”
Time Constraints
Regardless of its importance, the questionnaire can be daunting for family members who used to have to fill out their answers on paper, over multiple pages – admittedly, a time-drain for all involved. Staff estimate it took upwards of a half hour for families to complete it in paper form. Nurse care associates then had to enter the information into the system, easily taking 10 minutes per patient. It can be typical for a provider to see more than 20 patients a day.
Solution Developed
Israel Franco, MD, director of Yale Medicine’s Pediatric Bladder and Continence program, understands the questionnaire’s importance, but also the time difficulties that persist – spending the last 30+ years dedicated to treating these children and studying the often complex brain-bladder connections involved. He, along with Meghan Curran, MBA, BSN, and the EPIC health system team developed an electronic version of the questionnaire that is now available on touch-screen digital tablets at each Yale Urology pediatric clinic setting. Other online bed-wetting surveys exist, but Franco personally customized this with key elements in mind.
“The method was necessary to answer particular questions in a prospective manner for future research studies to help fine tune our treatments,” says Franco, who is considered an international expert on voiding dysfunction and its relationship to neuropsychiatric disorders in young people.
“We see a lot of children with anxiety, depression, ADHD, learning disabilities, and autism spectrum disorder,” explains Therese Collett-Gardere, a pediatric nurse practitioner who has worked with Franco for 20 years.
Added Benefits
“In many cases there is no prior identification of an underlying psychiatric diagnosis or of autonomic dysfunction,” adds Franco. “The questionnaire highlights these problems and brings to light previously undiagnosed or denied underlying issues … It can take a tremendous amount of work and effort to get these patients treated appropriately.” Franco and his clinical team [made up of Collett-Gardere, APRN, CPNP, Jamille Rancourt, PA, and Molly Band, PA] all feel strongly that the questionnaires help with the denial aspect, bringing education and awareness to parents as they answer each detailed question. The electronic version also helps with access. Those who don’t have dependable internet at home can now use the tablets right in the doctor’s office.
“We’ve found parents are less likely to skip a question with the electronic version … when somebody’s handed a tablet, there’s a heightened expectation of, ‘Okay, this information is needed’” says Conway. And that can help with the big picture, getting at the root of the issue, and ultimately gathering research data that drive discovery for less invasive treatments.
“I’m hoping this leads to other innovations that streamline care,” says Conway, who has also been a part of Franco’s team for years. “It’s really about the patient experience and this is just one facet of it.”