Laura Fanucchi

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

BACKGROUND Geographic localization of physicians to patient care units may improve communication, decrease interruptions, and reduce resident workload. This study examines whether interns on geographically localized patient care units receive fewer pages than those on teams that are not. METHODS The study is a retrospective analysis of the number of pages received by interns on 5 internal medicine teams: 2 in a geographically localized model (GLM), 2 in a partial localization model (PLM), and 1 in a standard model (SM) over 1 month at New York-Presbyterian Hospital/Weill Cornell. Multivariate linear regression techniques were used to analyze the relationship between the number of pages received per intern and the type of team. RESULTS The number of pages received per intern per hour, adjusted for team census and number of admissions, was 2.2 (95% confidence interval [CI]: 2.0-2.4) in the GLM, 2.8 (95% CI: 2.6-3.0) in the PLM, and 3.9 (95% CI: 3.6-4.2) in the SM; all differences were statistically significant (P < 0.001). CONCLUSION Geographic localization of resident teams to patient care units was associated with significantly fewer pages received by interns during the day. Such patient care models may improve resident workload in part by decreasing pages, and consequently has important implications for patient safety and medical education.

Putting Parity into Practice — Integrating Opioid-Use Disorder Treatment into the Hospital Setting

U.S. hospitalizations for severe infections associated with illicit opioid use have doubled over the past decade and are often prolonged and resource-intensive, but medication-assisted treatment for opioid use disorder can be integrated into hospital care.

Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record

BACKGROUND Communication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool. METHODS Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes. A third group of residents in each program served as control. Notes were evaluated with the Physician Documentation Quality Instrument 9 (PDQI-9). RESULTS Due to a significant difference in baseline PDQI-9 scores at MMC, the sites were not combined. Of 75 residents at the UK site, 22 were eligible, 20 (91%) enrolled, 76 notes in total were scored. Of 156 residents at MMC, 22 were eligible, 18 (82%) enrolled, 40 notes in total were scored. Note quality did not improve as measured by the PDQI-9. CONCLUSION This educational quality improvement project did not improve the quality of clinical documentation as measured by the PDQI-9. This project underscores the difficulty in improving note quality. Further efforts should explore more effective educational tools to improve the quality of clinical documentation in the EHR.

Authors' reply: "(re)turning the pages of residency: the impact of localizing resident physicians to hospital units on paging frequency".

METHODS: The study is a retrospective analysis of the number of pages received by interns on 5 internal medicine teams: 2 in a geographically localized model (GLM), 2 in a partial localization model (PLM), and 1 in a standard model (SM) over 1 month at New York–Presbyterian Hospital/Weill Cornell. Multivariate linear regression techniques were used to analyze the relationship between the number of pages received per intern and the type of team. RESULTS: The number of pages received per intern per hour, adjusted for team census and number of admissions, was 2.2 (95% confidence interval [CI]: 2.0–2.4) in the GLM, 2.8 (95% CI: 2.6–3.0) in the PLM, and 3.9 (95% CI: 3.6–4.2) in the SM; all differences were statistically significant (P<0.001).