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Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes Brown, Kyla N.; Leigh, Jeanna P.; Kamran, Hasham; Bagshaw, Sean M.; Fowler, Rob A.; Dodek, Peter M.; Turgeon, Alexis F.; Forster, Alan J.; Lamontagne, Francois; Soo, Andrea; et al.

Abstract

Background: Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. Methods: This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. Results: A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9–2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p < 0.001). There was a discrepancy between documentation of patient issues in the last ICU and first ward notes; mean agreement of patient issues was 42% [95% CI 31–53%]. Qualitative analyses identified eight themes related to focus (central point – e.g., problem list), structure (organization, – e.g., note-taking style), and purpose (intention – e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Conclusions: Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.

Item Metadata

Title
Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes
Creator
Brown, Kyla N.; Leigh, Jeanna P.; Kamran, Hasham; Bagshaw, Sean M.; Fowler, Rob A.; Dodek, Peter M.; Turgeon, Alexis F.; Forster, Alan J.; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T.
Publisher
BioMed Central
Date Issued
2018-01-28
Description
Background: Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. Methods: This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. Results: A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9–2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p < 0.001). There was a discrepancy between documentation of patient issues in the last ICU and first ward notes; mean agreement of patient issues was 42% [95% CI 31–53%]. Qualitative analyses identified eight themes related to focus (central point – e.g., problem list), structure (organization, – e.g., note-taking style), and purpose (intention – e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Conclusions: Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
Subject
Provider communication; Documentation; Patient transfer; Intensive care unit; Progress notes; Hospital ward
Genre
Article
Type
Text
Language
eng
Date Available
2018-01-31
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0363333
URI
http://hdl.handle.net/2429/64502
Affiliation
Medicine, Faculty of; Non UBC; Critical Care Medicine, Division of; Medicine, Department of
Citation
Critical Care. 2018 Jan 28;22(1):19
Publisher DOI
10.1186/s13054-018-1941-0
Peer Review Status
Reviewed
Scholarly Level
Faculty
Copyright Holder
The Author(s).
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Attribution 4.0 International (CC BY 4.0)