Validating the Physician Documentation Quality Instrument for Intensive Care Unit-Ward Transfer Notes

Area of Science:

• Medical Informatics
• Healthcare Quality Improvement
• Clinical Communication

Background:

• Physician communication failures during patient transfers from intensive care units (ICUs) to general wards are frequent and can lead to adverse events.
• Improving written handoff notes is crucial, yet no standardized instruments exist to evaluate the quality of these physician transfer notes.

Purpose of the Study:

• To gather validity evidence for the modified nine-item Physician Documentation Quality Instrument (mPDQI-9).
• To assess the usefulness of ICU-to-ward transfer notes across multiple hospital settings.

Main Methods:

• Twenty-four physician raters evaluated 12 transfer notes from three academic hospitals using the mPDQI-9.
• Specific domains assessed included thoroughness, usefulness, organization, comprehensibility, succinctness, synthesis, and consistency.
• Criterion validity (Spearman's ρ) and interrater reliability (intraclass correlation [ICC]) were primary measures.

Main Results:

• Mean mPDQI-9 scores varied by note, with perceived clinical utility showing a moderate positive correlation (ρ=0.48).
• Interrater reliability was strong (ICC=0.89), and internal consistency was good (Cronbach's α=0.87).
• Note ratings did not differ significantly based on rater expertise.

Conclusions:

• The mPDQI-9 provides moderate validity evidence for evaluating the usefulness of ICU-to-ward transfer notes.
• This instrument can aid in assessing and improving the quality of physician documentation during critical patient transitions.