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Documentation of Shared Decisionmaking in the Emergency Department
David Chartash1, Mona Sharifi2, Beth Emerson3
1Center for Medical Informatics, Yale University School of Medicine, New Haven, CT.
Annals of Emergency Medicine
|August 3, 2021
Summary
A new natural language processing tool accurately identifies shared decisionmaking in emergency department notes. Documentation of shared decisionmaking increased significantly from 2013-2020, but varied by provider and patient demographics.
Area of Science:
- Health Informatics
- Clinical Communication
- Emergency Medicine
Background:
- Patient-centered communication and shared decisionmaking are crucial in healthcare.
- Understanding their application in emergency departments (EDs) is limited.
- Real-world data on these practices in EDs is scarce.
Purpose of the Study:
- To develop and validate a natural language processing (NLP) tool for identifying shared decisionmaking (SDM) in ED clinical notes.
- To analyze patterns of SDM and general patient discussion in ED notes from 2013-2020.
- To explore factors associated with variations in SDM documentation.
Main Methods:
- Developed and validated an NLP tool using regular expressions to detect SDM and patient discussion in ED notes.
- Conducted a retrospective analysis of notes from a large health system (2013-2020).
- Utilized mixed-effects logistic regression and trend analysis to assess documentation patterns and associated factors.
Main Results:
- The NLP tool achieved high accuracy (96.7% for SDM, 88.9% for general discussion).
- SDM documentation increased by 300% and general discussion by 50% from 2013-2020.
- Higher odds of SDM documentation were observed for physicians vs. advanced practice providers, female vs. male patients, and patients with commercial insurance. Black patients had lower odds of SDM documentation compared to White patients.
Conclusions:
- An NLP tool effectively extracts SDM from ED notes, enabling large-scale analysis.
- SDM documentation in EDs has increased but shows significant variation.
- Demographic, social, temporal, and clinical factors influence SDM documentation in the ED.
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