Improving Patient Portal Enrollment in the Pediatric Emergency Department: A Quality Improvement Project

Purpose/Objectives: Access to a patient portal has been shown to improve patient satisfaction and customer retention, and increases telehealth options for families, which has become essential during COVID-19. Unfortunately, portal enrollment after emergency department (ED) visit has historically been very low at our institution, with less than one percent of patients enrolling within ten days of their visit. Our primary objective was to increase the percentage of eligible emergency department patients who enroll in the patient portal within 10 days of their ED visit from 0.3% to 5% by May 2021 and sustain improvements for 6 months.

Design/Methods: A multidisciplinary team of ED providers and ancillary staff developed a working group to create a key driver diagram and plan interventions across the department. Interventions focused on improving portal invite dissemination, improving visibility and access on our portal website, and enhancing access for families to receive an invite after departure. Data were collected on all eligible participants presenting to two urban freestanding pediatric emergency departments. Given portal age and security constraints, initial eligible patients were those aged 0-12 or 18 and older who were not previously enrolled (from baseline until March 2021). Secondary to the CURES Act and changes in the EHR (electronic health record), eligible patients from April 2021 onward included all patients not previously enrolled in all age groups. Sequential PDSA (Plan-Do-Study-Act) cycles were completed with review of monthly enrollment trends and implementation of new interventions to improve portal enrollment after discharge, including web-based changes, registration service changes, and education of ED faculty and staff on portal enrollment. We followed the percentage of invites sent and percent uptake as process measures.

Results: Prior to project initiation, baseline portal enrollment for eligible patients within 10 days of ED visit was 0.3%. A p-chart with monthly data shows significant and sustained improvement in patient portal enrollment with special cause variation and baseline shift to six percent at our main facility and three percent at our secondary site. Similar trends were observed at both ED sites. Website updates and educational interventions demonstrated the most significant changes. With CURES act implementation and changes to the institutions’ EHR invitation process, expected drops in enrollment were seen.

Conclusion/Discussion: Significant improvements in patient portal enrollment were made during this quality improvement project and appear to be sustained at this time. Further interventions to improve enrollment focusing on streamlined portal access between clinic and ED sites, as well as a centralized portal help desk, are planned to sustain these improvements.