P0011 - Back to Babies: Reducing Documentation time in the NICU

Background: There is no accepted best practice for generation and content of daily progress notes in the Neonatal Intensive Care Unit (NICU) .

Objectives: To implement a consistent documentation standard for a neonatology provider group at a level four 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 EMR documentation tasks.

Methods: A work-group including advanced practice providers (APPs) and physicians from the NICU was formed and met over six 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 every Monday for 6 months prior to implementation of new workflow as well as 6 months post implementation. Average time to note completion was compared in the pre and post intervention groups.

Results: 962 notes were sampled, 481 each in the pre and post intervention states. 20 neonatologists were captured in the pre-intervention state, 24 in the post intervention state, 18 were captured in both samples. Final note completion time mean improved from 10 hours and 32 minutes to 8 hours and 40 minutes (p < 0.01) (Fig 1). Those sampled in both epochs improved from 10 hours and 6 minutes to 8 hours and 30 minutes (p <0.05).

Conclusions: 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.