School of Medicine and Health Sciences Poster Presentations

Title

Electronic Medical Record Discharge Template Use Improves Resident Efficiency

Document Type

Poster

Keywords

QI; template; Discharge

Publication Date

Spring 2017

Abstract

George Washington University internal medicine residents are challenged to deliver evidence-based, humanistic, and high-quality medical care. However, much of their time is spent on documentation instead of direct patient care or scholarly activities. The introduction of electronic medical records (“EMR”) has provided an opportunity for the improvement of both efficiency and quality of patient care. In reality, capitalizing on this opportunity has been particularly difficult in academic settings that experience high patient turnover and employ resident physicians at varying levels of training. The discharge instruction (“DCI”), which details the reason for a patient’s hospitalization, is among the most important documentation that a resident is responsible for. Despite this, only 16% of internal medicine residency programs have a discharge planning curriculum. This was addressed in a prior quality improvement (“QI”) project at George Washington University. The results of that project showed that DCI standardization through the use of templates led to a decrease in drafting time in addition to an increase in quality. Subsequently, the EMR system at the site of the project was changed. The present QI project aimed to adopt those previous instructions and replicate those results in the new system.

Our aim was to increase the use of DCI templates by 25% in 4 months on the cardiology service. Templates were created for common diagnoses: acute heart failure exacerbation, syncope, noncardiac chest pain, and acute coronary syndrome. Initially, only 35% of respondents were using templates, however, after our final PDSA cycle 100% of respondents were using templates. This increase in use correlated with a decrease in the amount of time spent writing DCIs. The number of residents able to complete discharge instructions in less than 10 minutes increased by 28%. Despite the decrease in time, residents surveyed did not perceive a reduction in quality. Our study shows that the use of DCI templates or macros increases efficiency while maintaining quality. This will permit residents to devote more time to other aspects of patient care as well as to their pursuit of knowledge. Further PDSA cycles can be target the creation of additional templates for the cardiology service, and the expansion of template use to other services.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Poster to be presented at GW Annual Research Days 2017.

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Electronic Medical Record Discharge Template Use Improves Resident Efficiency

George Washington University internal medicine residents are challenged to deliver evidence-based, humanistic, and high-quality medical care. However, much of their time is spent on documentation instead of direct patient care or scholarly activities. The introduction of electronic medical records (“EMR”) has provided an opportunity for the improvement of both efficiency and quality of patient care. In reality, capitalizing on this opportunity has been particularly difficult in academic settings that experience high patient turnover and employ resident physicians at varying levels of training. The discharge instruction (“DCI”), which details the reason for a patient’s hospitalization, is among the most important documentation that a resident is responsible for. Despite this, only 16% of internal medicine residency programs have a discharge planning curriculum. This was addressed in a prior quality improvement (“QI”) project at George Washington University. The results of that project showed that DCI standardization through the use of templates led to a decrease in drafting time in addition to an increase in quality. Subsequently, the EMR system at the site of the project was changed. The present QI project aimed to adopt those previous instructions and replicate those results in the new system.

Our aim was to increase the use of DCI templates by 25% in 4 months on the cardiology service. Templates were created for common diagnoses: acute heart failure exacerbation, syncope, noncardiac chest pain, and acute coronary syndrome. Initially, only 35% of respondents were using templates, however, after our final PDSA cycle 100% of respondents were using templates. This increase in use correlated with a decrease in the amount of time spent writing DCIs. The number of residents able to complete discharge instructions in less than 10 minutes increased by 28%. Despite the decrease in time, residents surveyed did not perceive a reduction in quality. Our study shows that the use of DCI templates or macros increases efficiency while maintaining quality. This will permit residents to devote more time to other aspects of patient care as well as to their pursuit of knowledge. Further PDSA cycles can be target the creation of additional templates for the cardiology service, and the expansion of template use to other services.