Cross-Cover Documentation: Multicenter Development of Assessment Tool for Quality Improvement

Area of Science:

• Medical Informatics
• Patient Safety
• Healthcare Quality Improvement

Background:

• Cross-cover events occur when primary medical teams are unavailable for hospitalized patients.
• Effective documentation during cross-cover events is crucial for safe patient care transitions.
• Currently, no standardized tool exists to assess the quality of this documentation.

Purpose of the Study:

• To develop and validate an assessment tool to measure the quality of inpatient electronic health record documentation for cross-cover events.
• To evaluate the reliability and usability of the developed assessment tool.

Main Methods:

• An 8-item assessment tool was created and content-validated by 15 experts.
• Interrater reliability was measured using Cohen's kappa coefficient.
• The tool was used to score 222 cross-cover notes from internal medicine services at two academic hospitals.

Main Results:

• The assessment tool demonstrated good interrater agreement (Cohen's kappa = 0.76).
• Faculty-authored notes were of higher quality than resident-authored notes (89% vs. 74% of items present, p < .001).
• Common deficiencies included a lack of subjective information (60%), diagnosis (62%), and attending physician notification (7%).

Conclusions:

• The 8-item tool provides reliable measurement of cross-cover documentation quality.
• Significant improvements are needed in cross-cover education and documentation practices to ensure safe transitions of care for acutely ill patients.