A learning health systems approach to implementation and evaluation of an academic emergency department single shared...

The application of implementation science (IS) frameworks to evaluate quality process improvement initiatives in an academic emergency department (ED) setting offers a promising approach for learning health systems (LHS). This report describes the University of Colorado Department of Emergency Medicine's LHS partnership among clinical operations, data analytics, and IS experts to evaluate a novel shared note workflow.

The University of Colorado Health (UCH) ED, staffed with scribes, advanced practice providers, and physicians, implemented a shared note workflow in summer 2022. This workflow involved all parties in a clinical encounter using a single note template, unlike previous separate notes. An IS expert guided the evaluation using the implementation of change model and the theoretical domains framework, with surveys and Epic electronic health record (EHR) encounter data. Analysis included descriptive statistics and regression analysis, comparing note completion rates pre (summer 2021) and post (summer 2022 and 2023) shared notes.

Among 146 survey respondents, knowledge [M (SD) = 6.0 (0.9)] and confidence [5.5 (1.3)] following the new workflow were high (1-7 scale). Acceptability [M (SD) = 4.42 (0.80)], appropriateness [4.48 (0.70)], and feasibility [4.5 (0.61)] were also high (1-5 scale). EHR data showed note completion during the shift increased to 48.3% in 2022 from 32.2% in 2021, a 50% improvement (OR (95% CI) = 2.34 (2.28-2.40), p < 0.0001). By summer 2023, note completion attenuated to 41.3%, still significantly higher than pre-shared note workflow (OR (95% CI) = 1.96 (1.90-2.01), p < 0.0001).

This IS-enhanced LHS evaluation of a shared note workflow in an academic ED demonstrated high satisfaction and a positive impact on note completion during shifts. Timely note completion is crucial for reducing clinician burnout and providing high-quality care. IS methods provided data-driven insights to justify the sustainment of the shared note workflow to organizational leaders.