318 Taking air pollution data to the next level – displaying in the patients chart and empowering action

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A291 - A292
• Main Authors: Hayden, Mark, Andersson, Johanna, Wilson, Nicola, Fecht, Daniela
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Air pollution; Air pollution effects; Asthma; Education; Educational Resources; Electronic health records; Electronic medical records; Embedding; Medical records; Patients; Pediatrics; Pollution; Pollution dispersion; Preventable deaths; Primary care; Teaching Methods; Training
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.462

ObjectivesIn April 2021, the South London Coroner, Philip Barlow, concluded that 9yr old Ella Adoo Kissi Debrah died of asthma, contributed to by exposure to excessive air pollution.1 He criticised both medical and nursing staff for failing to adequately inform Ella’s mother of the risks. For his Chief Medical Officer’s 2022 report, Chris Whitty chose air pollution. His two recommendations to the NHS were to reduce our contribution to pollution from transport, heating etc and that;‘The training of healthcare staff should include the health effects of air pollution and how to minimise these, including communication with patients’2Despite the well-established and inequitable harm caused by air pollution, it was rarely included in clinical education until the coroner’s criticism in 2021. Upskilling clinicians is a significant task. Very few hospitals provide any education, and it is never mandatory. Most clinicians expect training and patient-specific data when asked to counsel patients on risk. Finding the local air-pollution data for a child attending our hospital would require significant effort. Our objective was to use our electronic medical record (EMR) to support clinicians with data and resources.MethodsFigure 1 illustrates our approach to supporting clinicians by embedding air pollution data for patients‘ postcode with supporting information, and curated actions, directly in our electronic medical record. Prior to launch we also surveyed clinicians and parents’ views to refine our build and provide a baseline.ResultsOur pre-launch survey showed that while only 15% of our staff would be comfortable with discussing air pollution with patients, 75% of families would like this to happen. The intervention went live in November 2022. Two of the authors have now commenced a formal trust wide QI project to expand teaching resources, increase staff engagement and to evaluate the project.ConclusionOur intervention has generated interest from other NHS trusts and both local and national government. Replicating our intervention would not be difficult, given that many trusts have similar or identical electronic medical record systems. With the valuable and continued support from Imperial College London to use their original data, the practice could be expanded nationally at pace. While, we will always place the child first and always, the impact would be still greater in a large mixed trust or in the primary care setting, so we encourage others our replicate our intervention.ReferencesRegulation 28: Report To Prevent Future Deaths. Barlow, P. (2022, 12 09). https://www.judiciary.uk/wp-content/uploads/2021/04/Ella-Kissi-Debrah-2021-0113-1.pdfChief-medical-officers-annual-report-2022-air-pollution. Whitty, C. (n.d.). 2022. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1121614/chief-medical-officers-annual-report-2022-air-pollution.pdfAbstract 318 Figure 1