A Quality Improvement Study to Improve Inpatient Problem List Use

BACKGROUND AND OBJECTIVES: The problem list (PL) is a meaningful use-incentivized criterion for electronic health record documentation. Inconsistent use or inaccuracy of the PL can create communication gaps among providers, potentially leading to diagnostic delays and serious safety events. The objective of the study was to increase the rate of PL review by attending physicians for inpatients discharged from hospital pediatrics and infectious disease services from a baseline of 70% to 80% by June 2018 and to sustain the rate for 6 months. The secondary aim was to improve PL accuracy by decreasing the rate of duplicate codes and red code diagnoses that should resolve before discharge from a baseline of 12% and 11%, respectively, to 5% and sustaining the rate for 6 months. METHODS: A quality improvement team used the Institute for Healthcare Improvement Model for Improvement. We tracked duplicate codes and red codes as surrogate markers of PL quality. Rates of PL review and PL quality were analyzed monthly via statistical process control charts (p-charts) with 3-s control limits to identify special cause variation. RESULTS: PL review improved from a baseline of 70% to 90%, and the change was sustained for 1 year. PL quality improved as duplicate codes at the time of discharge decreased from 12% to 6% and as red codes decreased from a baseline of 11% to 6%. CONCLUSIONS: The PL is an important communication tool that is underused. By engaging and educating stakeholders, incentivizing compliance, standardizing PL management, leveraging electronic health record enhancements, and providing physician feedback, we improved PL meaningful use and quality.

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“…The success of this project is similar to that in previously reported studies. 12,16,17 FIGURE 2 PL reviewed during admission: HP and ID.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Inpatient Problem List Review and Accuracy Improvement

Liao

Kasick

Allen

et al. 2020

Hospital Pediatrics

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“…10 Another approach is problem-based documentation, where clinicians document assessments and plans for each problem on the PL. 11,12 The increasing use of the EHR may help to implement Weed's vision and better support physician work so that recorded problems are connected to the relevant patient information in other parts of the EHR. 10,13 Research on the Electronic Problem List: Outpatient Settings Most studies on the electronic PL are performed in outpatient care settings.…”

Section: Emergence Of the Electronic Problem Listmentioning

confidence: 99%

“…Hospitalists and residents on the documentation committee provided feedback on interventions by sending biweekly e-mails with daily PL usage graphs; PL use improved from 27 to 97%. 11 Research on the PL in pediatric settings is limited, especially studies describing how physicians think it could be used in a pediatric inpatient setting.…”

Section: Extending Research On the Electronic Problem List From Outpamentioning

confidence: 99%

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

et al. 2019

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Objective To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. Methods We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline. Results We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. Conclusion Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.

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“… • Users should be trained in using the problem list, its features and policies on the problem list. This increases the correct use of the problem list [ 12 , 14 , 25 , 40 , 42 ] • Experience in medicine and medical profession also influences the use of the problem list this should be taken into account in training of staff [ 17 , 25 , 41 ] • Training can increase the correct use of the problem list [ 12 , 14 , 25 , 40 , 42 ] Usability The definition of usability in this article is user-friendliness and user interface. • Custom views and filters should be possible [ 2 , 8 , 18 , 39 ] • The interface should be intuitive and efficient [ 8 , 13 , 39 ] • The encoded dictionary should be able to identify synonyms, misspelled entries and handle free text [ 2 , 6 , 12 , 31 , 32 ] • System support has to be integrated at logical moments in the notes registry (e.g.…”

Section: Resultsmentioning

confidence: 99%

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature

Simons

Cillessen

Hazelzet

2016

BMC Med Inform Decis Mak

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BackgroundA problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing with the multiplicity of patient problems. The problem list as a precondition is the centerpiece of the problem-oriented medical record (POMR) also called problem-oriented record (POR).Prior to the digital era, paper records presented a flat list of medical problems to the healthcare professional without the features that are possible with current technology. In modern EHRs a POMR based on a structured problem list can be used for clinical decision support, registries, order management, population health, and potentially other innovative functionality in the future, thereby providing a new incentive to the implementation and use of the POMR.MethodsOn both 12 May 2014 and 1 June 2015 a systematic literature search was conducted. From the retrieved articles statements regarding the POMR and related to successful or non-successful implementation, were categorized. Generic determinants were extracted from these statements.ResultsIn this research 38 articles were included. The literature analysis led to 12 generic determinants: clinical practice/reasoning, complete and accurate problem list, data structure/content, efficiency, functionality, interoperability, multi-disciplinary, overview of patient information, quality of care, system support, training of staff, and usability.ConclusionsTwo main subjects can be distinguished in the determinants: the system that the problem list and POMR is integrated in and the organization using that system. The combination of the two requires a sociotechnical approach and both are equally important for successful implementation of a POMR. All the determinants have to be taken into account, but the weight given to each of the determinants depends on the organizationusing the problem list or POMR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0341-0) contains supplementary material, which is available to authorized users.

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A Quality Improvement Study to Improve Inpatient Problem List Use

Abstract: Significant gains were made with inpatient problem list usage by the medical and psychiatric teams. Our goal ascribed by meaningful use for >80% of inpatients to have a problem at discharge was met after initiation of our series of interventions.

Cited by 12 publications

References 12 publications

Pediatric Inpatient Problem List Review and Accuracy Improvement

Pediatric Inpatient Problem List Review and Accuracy Improvement

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature

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