Back to Babies: Reducing Documentation Time in the NICU

Background  There is no accepted best practice for generation and content of daily progress notes in the neonatal intensive care unit (NICU). Objectives  This study aimed to implement a consistent documentation standard process for a neonatology provider group at a level IV tertiary care NICU. The primary aim was to improve timeliness of daily progress note completion. Secondary aims were to maintain or improve clinician satisfaction, reduce variability, and reduce attending neonatologist electronic medical record (EMR) documentation tasks. Methods  We formed a work group including advanced practice providers (APPs) and physicians from the NICU that met over 6 months to define the ideal NICU documentation content, map the workflow for documentation, identify gaps in EMR content, and create solutions for each gap. Baseline assessment included a change readiness survey to identify barriers to workflow change and a review of neonatologist signature timestamp to determine time to note completion. Twenty random progress notes were sampled weekly for 6 months prior to implementation of new workflow as well as 6 months postimplementation. Average time to note completion was compared in the pre- and postintervention groups. Results  In total, 962 notes were sampled, 481 each in the pre- and postintervention states. Twenty neonatologists were captured in the preintervention state, 24 in the postintervention state, 18 were captured in both samples. Final note completion time mean improved from 10 hours and 32 minutes (from starting note to final sign) to 8 hours and 40 minutes ( p  < 0.01). Those sampled in both epochs improved from 10 hours and 6 minutes to 8 hours and 30 minutes ( p  < 0.05). Conclusion  Progress notes generated by neonatologists are completed earlier than those generated by an APP with a Neonatologist addendum. Specialty-specific education and training are critical to high satisfaction in large EMR workflow transitions.