O2009: Sharing Is Caring: Implementation of a Shared Collaborative Provider Note in the Pediatric Emergency Department

Background: Nearly half of pediatric emergency medicine physicians are experiencing burnout (Kondrich, Han et al. 2022). Despite this, no industry standards exist for optimal documentation workflows within a pediatric academic emergency department (ED). Unique challenges exist within academic hospitals working with multiple provider levels (residents, fellows, attendings), all weaving together to tell a patient’s story. Even more considerations are needed when accounting for the 21st Century Cures Act when caring for pediatric and adolescent patients. We will discuss the implementation of a single collaborative provider note for ED encounters at an academic pediatric hospital. Our outcome metrics include provider satisfaction, time spent on documentation, length of documentation, and clarity of documentation.

Methods: To implement the change, we engaged our hospital’s Business Process Improvement department for change management strategies. Changes to the note template within the electronic health record (EHR) included adaptations to bring added visibility to which team member authored each portion of the note and changes to reduce inadvertent breaches of patient confidentiality.

To assess the impact of our change, we surveyed all ED provider levels as well as those providing downstream care, admitting physicians and primary care providers, before and after implementation. Likert scale measures were used to assess provider satisfaction and clarity.

We queried discrete information within individual note records stored in the electronic health record to compare time spent on notes and note length for the 4 months before and after the implementation of a single shared provider note.

Results: When converted to a 5-point Likert Scale (1 = very dissatisfied, 5 = very satisfied), ED provider satisfaction with personal documentation workflows improved from 2.82 (n = 34 responses) to 4.35 (n = 37). Providers also reported less information duplication within their documentation and enhanced documentation clarity compared to before implementation.

ED encounters for the 4 months prior to the transition to the shared note (n = 29,910 patient encounters) were compared to the 4 months after implementation (n = 26,608). Decreases in time spent in notes per encounter were seen for attending providers (12 min 50 sec to 7 min 33 sec), fellows (16 min 36 sec to 9 min 20 sec), and residents (21 min 28 sec to 16 min 00 sec). Total ED documentation length decreased from 6155 characters to 4762 characters for physician encounters.

Conclusion: The high demands of a fast-paced pediatric ED require efficient provider workflows. Provider documentation burden should be an ongoing consideration and area of research given its impact on burnout. Our change to a collaborative shared note in an academic pediatric ED highlighted our prior inefficiencies and led to both subjective and objective improvements in the provider and care team experience.