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American Academy of Pediatrics
Brief Reports

Evaluation and Improvement of Intern Progress Note Assessments and Plans

Michelle M. Kelly, Daniel J. Sklansky, Kirstin A.M. Nackers, Ryan J. Coller, Shannon M. Dean, Jens C. Eickhoff, Nicole L. Bentley, Carrie L. Nacht and Kristin A. Shadman
Hospital Pediatrics April 2021, 11 (4) 401-405; DOI: https://doi.org/10.1542/hpeds.2020-003244
Michelle M. Kelly
aDepartments of Pediatrics and
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Daniel J. Sklansky
aDepartments of Pediatrics and
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Kirstin A.M. Nackers
aDepartments of Pediatrics and
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Ryan J. Coller
aDepartments of Pediatrics and
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Shannon M. Dean
aDepartments of Pediatrics and
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Jens C. Eickhoff
bBiostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin; and
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Nicole L. Bentley
cUnityPoint Health, Waterloo, Iowa
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Carrie L. Nacht
aDepartments of Pediatrics and
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Kristin A. Shadman
aDepartments of Pediatrics and
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Abstract

OBJECTIVES: Progress notes communicate providers’ assessments of patients’ diagnoses, progress, and treatment plans; however, providers perceive that note quality has degraded since the introduction of electronic health records. In this study, we aimed to (1) develop a tool to evaluate progress note assessments and plans with high interrater reliability and (2) assess whether a bundled intervention was associated with improved intern note quality without delaying note file time.

METHODS: An 8-member stakeholder team developed a 19-item progress note assessment and plan evaluation (PNAPE) tool and bundled intervention consisting of a new note template and intern training curriculum. Interrater reliability was evaluated by calculating the intraclass correlation coefficient. Blinded assessors then used PNAPE to evaluate assessment and plan quality in pre- and postintervention notes (fall 2017 and 2018).

RESULTS: PNAPE revealed high internal interrater reliability between assessors (intraclass correlation coefficient = 0.86; 95% confidence interval: 0.66–0.95). Total median PNAPE score increased from 13 (interquartile range [IQR]: 12–15) to 15 (IQR: 14–17; P = .008), and median file time decreased from 4:30 pm (IQR: 2:33 pm–6:20 pm) to 1:13 pm (IQR: 12:05 pm–3:59 pm; P < .001) in pre- and postintervention notes. In the postintervention period, a higher proportion of assessments and plans indicated the primary problem requiring ongoing hospitalization and progress of this problem (P = .0016 and P < .001, respectively).

CONCLUSIONS: The PNAPE tool revealed high reliability between assessors, and the bundled intervention may be associated with improved intern note assessment and plan quality without delaying file time. Future studies are needed to evaluate whether these improvements can be sustained throughout residency and reproduced in future intern cohorts and other inpatient settings.

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Hospital Pediatrics: 11 (4)
Hospital Pediatrics
Vol. 11, Issue 4
1 Apr 2021
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Evaluation and Improvement of Intern Progress Note Assessments and Plans
Michelle M. Kelly, Daniel J. Sklansky, Kirstin A.M. Nackers, Ryan J. Coller, Shannon M. Dean, Jens C. Eickhoff, Nicole L. Bentley, Carrie L. Nacht, Kristin A. Shadman
Hospital Pediatrics Apr 2021, 11 (4) 401-405; DOI: 10.1542/hpeds.2020-003244

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Evaluation and Improvement of Intern Progress Note Assessments and Plans
Michelle M. Kelly, Daniel J. Sklansky, Kirstin A.M. Nackers, Ryan J. Coller, Shannon M. Dean, Jens C. Eickhoff, Nicole L. Bentley, Carrie L. Nacht, Kristin A. Shadman
Hospital Pediatrics Apr 2021, 11 (4) 401-405; DOI: 10.1542/hpeds.2020-003244
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