WIP 15 - Take Note: A Quality Improvement Project to Decrease Infectious Diseases Documentation Time

Publication Number: WIP 15.7641

Sarah Benke, Children's National Medical Center, Washington, DC, United States; Roya Gordji, Children's National Medical Center, Washington, DC, United States; Craig A. Shapiro, George Washington University School of Medicine and Health Sciences, Washington, DC, United States

Background: Documentation accounts for a significant amount of a physician’s daily workload (>30%) and can negatively impact face-to-face time with patients. Despite advancements in the electronic health record (EHR), a national comparison of ambulatory physicians across specialties showed that infectious diseases (ID) physicians spent the most time in the EHR outside of clinic hours. As physician burnout rises, it is important to develop ways that reduce time spent performing documentation. Our preliminary data indicates 75% of ID fellows feel that documentation is the most time-consuming aspect of service. 87.5% of ID fellows subjectively spend 3 to < 7 hours writing notes while on service in the fall and winter months. We hypothesize that decreasing time spent on documentation can benefit work-life balance and consequently help to provide overall better patient care and more timely recommendations.

Objective: To decrease documentation time by 10% for pediatric ID fellows on a general inpatient service at a large free standing children’s hospital by March 2025.

Design/Methods: Quality Improvement project with IRB exemption. Baseline data were collected in October 2024 to determine subjective evaluation of documentation time and additional duties outside of direct patient care by ID fellows while on general inpatient service. Following collection of baseline data, standardized assessment and plan templates were created as dot phrases for common ID consult questions. During the first PDSA cycle, ID fellows are asked to use the dot phrases for a three-month period before a post-intervention survey will be distributed to evaluate subjective documentation time and assess for any changes. EHR analytic tools will be used to assess the outcome measure of documentation time by ID fellows and the process measure of frequency of use of standardized dot phrases. Balancing measures include appropriateness of the plan regarding antibiotic selection and errors in documentation. Data will be analyzed via descriptive analyses and run charts.