The Impact of Diagnosis-Specific Plan Templates on Admission Note Writing Time: A Quality Improvement Initiative

Abstract

Background There are limited objective studies regarding the effectiveness of strategies to alleviate the documentation burden on resident physicians. Objective To develop and implement diagnosis-specific templates for the plan of care section of inpatient admission notes, aiming to reduce documentation time. Methods Twelve templates for the plan of care section of admission notes were written by the study authors, reviewed by attending physicians, and shared with the residents through the electronic health record (EHR) on September 23, 2022. EHR audit log data were collected to examine admission note writing times, supplemented by resident feedback on acceptability via an anonymous survey. Feasibility measures included time investment, experience with the EHR, and resident training. Results Between July 1, 2021 and June 30, 2023, 62 pediatric residents contributed 9840 admission notes. The templates were used in 557 admission notes. The mean total time spent on an admission note decreased from 97.9 minutes pre-intervention to 71.0 minutes post-intervention with the use of a template; an adjusted reduction of 23% (95% CI 16%-30%; P<.001). The mean attending time spent editing an admission note was unchanged. The survey results underscored wide acceptability of the templates among the residents. Feasibility data showed that the project required minimal time investment from the health care informatics team and minimal resident training. Conclusions Using templates in the care plan section of admission notes reduces the time residents spend writing admission notes.

Figure 1

Temporal Trend of Admission Notes Writing Times by Academic Block Note: Line graph tracking the median writing times for admission notes across different time blocks. An academic year is divided into 13 blocks, each 4 weeks in duration (ie, academic year [AY] 2021-2022 begins with block 1 and AY 2022-2023 begins with block 14). The graph displays median times along with lower and upper quartiles.

Figure 2

Comparison of Mean Admission Note Time With 95% Confidence Limits Pre- and Post-Intervention, With and Without Template Use Note: Shown are mean admission note total time, resident time, resident time stratified by postgraduate year (PGY), and attending time. For further details on the impact of the templates on resident time overall and at different PGYs, refer to the online supplementary data section E.

Figure 3

Percent Differences in Mean Admission Note Time Pre- and Post-Intervention, With and Without Template Use Note: The estimate of mean differences has been adjusted to control for service unit, and for percent contribution to total time for resident time and attending time. Mean difference with confidence limits that include zero is not statistically significant.

Figure 4

Survey Results Pre-Intervention and Post-Intervention Note: One month before (upper plot), and 6 months following (lower plot) the introduction of the plan templates, residents were asked to indicate their level of agreement with 4 statements regarding the writing of admission notes.