New Coding Guidelines Reduce Emergency Department Note Bloat But More Work Is Needed - 20/11/23
Abstract |
Study objective |
The length and redundancy of notes authored by clinicians has significantly increased, giving rise to the term “note bloat.” We analyzed the impact of new coding guidelines and documentation best practices on the length of emergency department (ED) notes and the amount of time clinicians spent documenting.
Methods |
In a large, multisite health care delivery organization, we retrospectively evaluated the length of all ED provider notes and the amount of time clinicians spent documenting between February 2018 and June 2023. In January 2023, we implemented changes to the standardized note template to align with the new coding guidelines from the American Medical Association and the Centers for Medicare & Medicaid Services. The primary outcomes were the length of provider notes and the amount of time spent documenting.
Results |
Our study sample consisted of 1,679,762 ED provider notes. Six months after the intervention, the average note length decreased by 872 words (95% confidence interval 867 to 877 words), whereas the amount of time clinicians spent documenting did not change.
Conclusions |
Embracing new guidelines and practices, we reduced the length of ED provider notes by 872 words. Despite this, the time clinicians spent documenting did not change significantly. We provide an early report of success in reducing note bloat in the ED to help guide future efforts to reduce overall documentation burden.
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| Please see page 714 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: David L. Schriger, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: All authors conceptualized the project and work. KM conducted analyses and drafted the initial manuscript. RS provided leadership support for the project and gave input on the interventions and manuscript. BH provided operational guidance on project implementation and gave input on manuscript revisions. DKV guided study design, oversaw analysis, and provided manuscript revisions. KM takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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| Data sharing statement: The entire deidentified dataset, data dictionary, and analytic code for this investigation are available upon request, from the date of article publication, by contacting Kyle Marshall at kamarshall@geisinger.edu. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 82 - N° 6
P. 713-717 - dicembre 2023 Ritorno al numero
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