Smarter Documentation: Measuring and Improving the Quality of Progress Notes Written by Hospitalists.

BACKGROUND

Progress notes written about hospitalized patients are suboptimal. Notes are bloated and awash with inaccuracies. Poor notes negatively impact patient care.

OBJECTIVE

To design and assess a progress note scoring rubric and educational intervention aimed at improving the quality of progress notes.

DESIGN

Randomized control educational trial.

PARTICIPANTS

Hospitalist physicians at a large academic medical center.

INTERVENTION

Hospitalists were randomized to either a multi-pronged educational intervention or the control group.

MAIN OUTCOME MEASURE

A scoring rubric was developed to measure the quality of progress notes; validity evidence was established for the measure. This rubric was used by assessors (blinded to both group and pre/post periods) to evaluate progress notes. Notes were pulled from 6 months before and after the intervention period (n = 156 notes).

KEY RESULTS

Of the 26 participating hospitalists, 14 were randomized to the intervention. The two groups of hospitalists were similar in terms of age, gender, and clinical experience (all p > 0.05). Both groups had comparable notes at baseline (total score, 0.32 vs. 0.30, p = 0.59). After participating in the educational session, all 14 of the rubric items were higher in the intervention group-both compared to the control group and to their baseline/PRE notes-many changes reaching statistical significance. Total scores for the intervention group improved significantly (all p < 0.05). The instruments' total score and global rating of "how well the note would prepare the next provider to take over the care of the patient" were highly correlated-0.72. Note length was not extended by the intervention (p > 0.05).

CONCLUSIONS

This work established both an objective scoring rubric to assess the quality of progress notes and an efficient, impactful method for coaching hospitalists. For other groups striving to improve progress note quality, this study provides a blueprint for how they might proceed.