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CC BY 4.0 · ACI open 2024; 08(01): e16-e24
DOI: 10.1055/s-0044-1782531
Research Article

Back to Babies: Reducing Documentation Time in the NICU

Shama Y. Patel
1   Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, United States
3   Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Rebecca S. Rose
4   Division of Neonatal-Perinatal Medicine, Department of Pediatrics Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Emily C. Webber
5   Department of Pediatrics Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, United States
› Author Affiliations Funding None declared.
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Abstract

Background There is no accepted best practice for generation and content of daily progress notes in the neonatal intensive care unit (NICU).

Objectives This study aimed to implement a consistent documentation standard process for a neonatology provider group at a level IV tertiary care NICU. The primary aim was to improve timeliness of daily progress note completion. Secondary aims were to maintain or improve clinician satisfaction, reduce variability, and reduce attending neonatologist electronic medical record (EMR) documentation tasks.

Methods We formed a work group including advanced practice providers (APPs) and physicians from the NICU that met over 6 months to define the ideal NICU documentation content, map the workflow for documentation, identify gaps in EMR content, and create solutions for each gap. Baseline assessment included a change readiness survey to identify barriers to workflow change and a review of neonatologist signature timestamp to determine time to note completion. Twenty random progress notes were sampled weekly for 6 months prior to implementation of new workflow as well as 6 months postimplementation. Average time to note completion was compared in the pre- and postintervention groups.

Results In total, 962 notes were sampled, 481 each in the pre- and postintervention states. Twenty neonatologists were captured in the preintervention state, 24 in the postintervention state, 18 were captured in both samples. Final note completion time mean improved from 10 hours and 32 minutes (from starting note to final sign) to 8 hours and 40 minutes (p < 0.01). Those sampled in both epochs improved from 10 hours and 6 minutes to 8 hours and 30 minutes (p < 0.05).

Conclusion Progress notes generated by neonatologists are completed earlier than those generated by an APP with a Neonatologist addendum. Specialty-specific education and training are critical to high satisfaction in large EMR workflow transitions.

Keywords

electronic health records - documentation - neonatal intensive care unit - workflow

Protection of Human and Animal Subjects

This project was reviewed by the Indiana University Human Research Protection Program and was determined that it does not require IRB review.




Publication History

Received: 08 September 2021

Accepted: 20 December 2023

Article published online:
20 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Adler-Milstein J, Jha AK. HITECH Act drove large gains in hospital electronic health record adoption. Health Aff (Millwood) 2017; 36 (08) 1416-1422
    CrossrefPubMedGoogle Scholar
  • 2 Shoolin J, Ozeran L, Hamann C, Bria II W. Association of Medical Directors of Information Systems consensus on inpatient electronic health record documentation. Appl Clin Inform 2013; 4 (02) 293-303
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Weed LL. Medical records that guide and teach. N Engl J Med 1968; 278 (11) 593-600
    CrossrefPubMedGoogle Scholar
  • 4 Palma JP, Brown PJ, Lehmann CU, Longhurst CA. Neonatal informatics: optimizing clinical data entry and display. Neoreviews 2012; 13 (02) 81-85
    PubMedGoogle Scholar
  • 5 Kim GR, Lawson EE, Lehmann CU. Challenges in reusing transactional data for daily documentation in neonatal intensive care. AMIA Annu Symp Proc 2008; 1009
    PubMedGoogle Scholar
  • 6 Lowe WW, Ciszek TA, Gallaher KJ. Comprehensive computerized neonatal intensive care unit data system including real-time, computer-generated daily progress notes. Pediatrics 1992; 89 (01) 62-66
    CrossrefPubMedGoogle Scholar
  • 7 Liu W, Walsh T. The Impact of Implementation of a clinically integrated problem-based neonatal electronic health record on documentation metrics, provider satisfaction, and hospital reimbursement: a quality improvement project. JMIR Med Inform 2018; 6 (02) e40
    CrossrefPubMedGoogle Scholar
  • 8 Kahn D, Stewart E, Duncan M. et al. A prescription for note bloat: an effective progress note template. J Hosp Med 2018; 13 (06) 378-382
    CrossrefPubMedGoogle Scholar
  • 9 Stewart E, Kahn D, Lee E. et al. Internal medicine progress note writing attitudes and practices in an electronic health record. J Hosp Med 2015; 10 (08) 525-529
    CrossrefPubMedGoogle Scholar
  • 10 Jalota L, Aryal MR, Mahmood M, Wasser T, Donato A. Interventions to increase physician efficiency and comfort with an electronic health record system. Methods Inf Med 2015; 54 (01) 103-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Davis T, Bice C. Arch Collaborative Guidebook 2019. KLAS Arch Collaborative. July 2019 . Accessed May 17, 2020
    PubMedGoogle Scholar
  • 12 Robinson KE, Kersey JA. Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout. Medicine (Baltimore) 2018; 97 (38) e12319
    CrossrefPubMedGoogle Scholar
  • 13 Hron JD, Lourie E. Have you got the time? Challenges using vendor electronic health record metrics of provider efficiency. J Am Med Inform Assoc 2020; 27 (04) 644-646
    CrossrefPubMedGoogle Scholar
  • 14 Aylor M, Campbell EM, Winter C, Phillipi CA. Resident notes in an electronic health record. Clin Pediatr (Phila) 2017; 56 (03) 257-262
    CrossrefPubMedGoogle Scholar
  • 15 Cao J, Farmer R, Carry PM. et al. Standardized note templates improve electronic medical record documentation of neurovascular examinations for pediatric supracondylar humeral fractures. JBJS Open Access 2017; 2 (04) e0027
    CrossrefPubMedGoogle Scholar