95. IMPROVING RESIDENT NOTE COMPLETION IN A GENERAL PEDIATRICS CLINIC

Abstract

Background Timely note completion is an important part of patient care. Our hospital has standard expectations for note completion; however, pediatric residents in our program were often delinquent in their documentation, resulting in incomplete patient data in the electronic health record during return visits, elevated resident stress, and threat of suspension of clinical duties from the professional board. The vast majority of these delinquencies were from our general pediatric clinic, where residents see patients for both acute and well child care. Aim Statement Decrease number of delinquent resident notes by 80% over a 9 month period. Interventions We used problem solving methodology and serial tests of change to improve note timeliness. The primary outcome measure was the number of overall delinquent charts according to a weekly graduate medical education deficiency notification system. Tests of change included: 1-Program Director emails and pages to residents with delinquent notes (defined by the institution as >14 days for ambulatory charts) 2-General Pediatric attending consensus on note completion timeliness (same day for acute care visits, next day for well child visits) 3-Intermittent auditing and real time alerts by administrative staff for residents who failed to comply with the same day/next day clinic note completion timeline. Measures Number of delinquent charts by pediatric residents according to the weekly graduate medical education deficiency notification system. Results Timely note completion improved significantly over the 13 months of the project. Program Director emails/pages to residents with deficient charts resulted in a reduction of a median 26 deficient charts/week to 12 deficient charts/week. Intermittent real time alerts to residents who failed to close charts within 24 hours of an acute care visit or 48 hours of a well child visit further reduced the median from 12 charts per week to 2 charts per week. Conclusions and Next Steps Standard expectations for resident note completion in a general pediatric clinic coupled with real time feedback improved resident adherence to institutional expectations around timely note completion. While program director contact with residents who have delinquent charts demonstrated some improvement, this intervention alone was insufficient.