Effects of a Designated Note Writing Hour on Pediatric Intern Adherence to Duty Hours

Area of Science:

• Medical Education
• Healthcare Administration
• Clinical Informatics

Background:

• Pediatric interns dedicate significant work hours to note writing, reducing time for direct patient care.
• The 80-hour workweek has been associated with interns spending only 12% of their time in direct patient care versus 40% at a computer.

Purpose of the Study:

• To evaluate the impact of a dedicated note-writing hour on pediatric intern note completion behaviors.
• To determine if this intervention could achieve 80% of notes completed before the end of the intern shift.

Main Methods:

• Utilized time stamps from the EPIC electronic health record (EHR) database.
• Analyzed note completion data for pediatric interns across three periods: pre-implementation, immediately post-implementation, and one year post-implementation.

Main Results:

• Note completion by sign-out increased from 67.9% to 73.5% post-implementation.
• The percentage of notes completed within the protected hour rose from 34.0% to 53.7%.
• The proportion of notes finished in under one hour improved significantly, though with variability.

Conclusions:

• A designated note-writing hour is an effective intervention for enhancing intern note-writing efficiency.
• The study did not meet its primary objective of 80% note completion by sign-out.
• Further strategies may be needed to fully optimize intern documentation workflows.