Search

OBJECTIVES: Progress notes communicate providers’ assessments of patients’ diagnoses, progress, and treatment plans; however, providers perceive that note quality has degraded since the introduction of electronic health records. In this study, we aimed to (1) develop a tool to evaluate progress note assessments and plans with high interrater reliability and (2) assess whether a bundled intervention was associated with improved intern note quality without delaying note file time. METHODS: An 8-member stakeholder team developed a 19-item progress note assessment and plan evaluation (PNAPE) tool and bundled intervention consisting of a new note template and intern training curriculum. Interrater reliability was evaluated by calculating the intraclass correlation coefficient. Blinded assessors then used PNAPE to evaluate assessment and plan quality in pre- and postintervention notes (fall 2017 and 2018). RESULTS: PNAPE revealed high internal interrater reliability between assessors (intraclass correlation coefficient = 0.86; 95% confidence interval: 0.66–0.95). Total median PNAPE score increased from 13 (interquartile range [IQR]: 12–15) to 15 (IQR: 14–17; P = .008), and median file time decreased from 4:30 pm (IQR: 2:33 pm–6:20 pm) to 1:13 pm (IQR: 12:05 pm–3:59 pm; P < .001) in pre- and postintervention notes. In the postintervention period, a higher proportion of assessments and plans indicated the primary problem requiring ongoing hospitalization and progress of this problem (P = .0016 and P < .001, respectively). CONCLUSIONS: The PNAPE tool revealed high reliability between assessors, and the bundled intervention may be associated with improved intern note assessment and plan quality without delaying file time. Future studies are needed to evaluate whether these improvements can be sustained throughout residency and reproduced in future intern cohorts and other inpatient settings.

Introduction Physicians enter residency with variable proficiency in note writing and knowledge of note purpose. Best practice guidelines give learners some direction, but may not provide adequate explanation about the importance and purposes of progress notes. Objective Test the efficacy of a workshop intervention on changing resident knowledge, attitudes, and beliefs about progress notes. Methods An educational workshop was constructed by residents and faculty stakeholders based on review of the literature, institutional best practices, and a previously designed note assessment tool. Residents from a mid-sized pediatric residency program attended a workshop consisting of best practice didactics and small group work using the tool to assess example progress notes. Participants completed a 22-question online survey (Qualtrics) before and after the workshop to evaluate knowledge of progress note components and attitudes regarding note importance. Pre-post analysis was performed with Chi square testing for true/false questions and Mann-Whitney testing for Likert scale questions. Results Pediatric residents (n=26, 79% response rate) completed the pre-intervention online survey, and 23 (70%) completed the post-intervention survey. Accurate response rate improved in 15/20 of the true/false content questions, with a statistically significant improvement in five of them (p Discussion/Conclusion This study suggests that a workshop intervention is an effective method of educating pediatric residents on progress note best practices. Further studies should assess the impact of the intervention on sustained resident knowledge and beliefs about progress notes and subsequent note quality.

Background Daily progress notes are vital cross disciplinary communication tools. The electronic medical record has influenced progress note content and length. Previously developed note assessment tools, such as the Physician Documentation Quality Instrument (PDQI-9), have not focused on the assessment and plan of the note, which are often most informative. Objective Develop a reliable and valid tool to evaluate the assessment and plan of resident daily progress notes. Methods A committee of pediatric resident, hospitalist and critical care physicians generated a list of common pitfalls associated with daily progress notes. A standardized ideal progress note assessment and plan was developed using a cause and effect diagram, literature review, consultation with billing expert and institutional documentation best practice guidelines. From this ideal state, a progress note evaluation tool PNAPE was developed using Modified Delphi technique. Four faculty experts used PNAPE and PDQI-9 to independently review resident progress notes identified from a convenience sample from each intern on the hospitalist service in fall 2017. Inter-rater reliability of the PNAPE was assessed using intraclass correlation coefficient (ICC). External validity was assessed by correlation between mean PNAPE and PDQI-9 scores using Pearson's coefficient. Results PNAPE is shown in figure 1. In all, 13 Notes were assessed with an ICC of 0.85. Pearson's r is 0.63 between mean PNAPE and PDQI-9 scores. Conclusion These findings suggest that the PNAPE is a reliable and valid tool for evaluation of resident progress note assessment and plan by expert assessors. Next steps will include use of PNAPE to track note quality over time, provide feedback and to assess notes in other inpatient settings and specialties.