The effect of template charting on chest pain documentation by attending physicians and physicians in training

Study objectives: We compare the documentation of critical items by attending physicians and physicians in training when evaluating patients with nontraumatic chest pain (NTCP) before and after the implementation of a chest pain evaluation form (CPEF) in a university hospital emergency department (ED). Methods: Using the American College of Emergency Physicians Clinical Policy for Adults Presenting with Chest Pain, a CPEF was designed and implemented in the ED to document the evaluation of patients presenting with NTCP. The CPEF contained critical documentation items (CDIs) listed as questions on the form with boxes for a response. After approval from the institutional review board, the records of 250 patients presenting with NTCP were retrospectively reviewed before and after the implementation of the CPEF for the presence of 28 CDIs and the identity of the primary documenter (attending physician versus physician in training, a senior student, or rotating resident). Overall and individual comparisons of the CDI documented by the 2 groups with and without the CPEF were analyzed using 2-sample z tests. Results: Using the CPEF, a significant increase in the percentage of items documented occurred for both the attending physician and physician in training groups compared with the blank form (attending physician without CPEF, n=60, CDI=36%, SD=24%; attending physician with CPEF, n=78, CDI=89%, SD=8%; physician in training without CPEF, n=186, CDI=39%, SD=23%; physician in training with CPEF, n=167, CDI=91%, SD=8%). Each CDI was documented significantly more often with the CPEF by both groups, with the exception of chest radiograph results, which were documented at a high level by the attending physician group before the implementation of the CPEF. Overall, there was not a significant difference between the attending physician and physician in training groups in the percentage of items documented, either before or after the implementation of the CPEF. When the frequency of individual CDI documentation was compared between groups, the physician in training group was significantly better at documenting specifics about the maximum pain ( P P P P P P Conclusion: Template-based documentation significantly improved the number of critical items documented during the evaluation of patients with NTCP. The improvement in documentation was seen for attending physicians and physicians in training. Although some specific differences were seen, there was no significant difference when comparing the overall effect of the template on the 2 groups. For physicians in training, the apparent value of template documentation may likely be continued reinforcement of CDI, and, for attending physicians, to be increased regulatory compliance.