P1227 - Improved Timely Documentation and Chart Encounter Closure Rates With the Implementation of a Validated Quality Improvement Process in the Division of Gastroenterology and Hepatology

Award: Presidential Poster Award

Quarshie Glover, MBChB¹, Mark Benson, MD², Kevin Patel, MD², Jennifer Weiss, MD, MS², Monica Zablotney, ARNP³, Jacqueline Stubbe, RN³, Brittney Kile, RN, MSN³, Taylor Gaffney, MBA³, Mathieu Ambrose, RN³, Deepak Gopal, MD, FACG^2
1University of Wisconsin Hospitals and Clinics, Madison, WI; ²University of Wisconsin School of Medicine, Madison, WI; ³UW Health, Madison, WI

Introduction: Untimely, incomplete clinical documentation impacts quality of care, delays communication, and decreases clinical revenue. Our Division of Gastroenterology & Hepatology (GI/Hep) was one of the Department of Medicine (DOM) divisions with a greater than average number of incomplete charts. The aim of our study was to develop a quality improvement (QI) intervention to significantly decrease the number of patient encounters open >30 + days for a multi-specialty GI/Hep division at a tertiary care academic practice.

Methods: Baseline data on chart closure was obtained from the biannual Organizational Professional Performance Evaluation (OPPE) report and performance based on 6-month cumulative in-basket weekly reports. Using a validated QI process and root cause analysis (RCA), barriers to timely chart completion were identified and appropriate interventions implemented. These included altering provider and nursing workflows, educating providers during division meetings, providing resources like smart real-time voice-to-text dictation services, medical scribes, templated clinic notes, and training with our electronic health record (EHR) team. Providers received weekly reminders regarding outstanding charts. We compared the total number of patient encounters open per provider and the number of encounters open at > 30+ days before the division QI intervention to 6 months post-intervention during the study period 9/1/2021 to 2/28/2022.

Results: During the study period, the GI/Hep division saw a mean of 1,582 ambulatory clinic visits per month. There was a significant decrease in the mean total number of open encounters per provider pre-intervention, 22.4 (±5.1), compared to post, 3.2 (±8), P=0.0003. In addition, there was a significant decrease in the mean number of encounters open > 14+ days, 19.5 (±4.5) vs 2.6 (±7), P=0.0005 and for encounters open for > 30 + days, 3.6 (±7) vs 0.5 (±2), P=0.0009. (Figure 1) The percentage of providers with open charts only > 30 + days in the division also reduced from 48.8% to 17% over, with the average number of open charts decreasing from 15 to 3 post-intervention over four 6-month OPPE cycles. We also had an additional 4-month post-study period data showing sustained trends.

Discussion: Validated QI tools and provider education results in significant, sustained improvement in provider clinical chart encounter completion. GI/Hep practices should be aware of their practice's chart completion rates and use a QI process as needed to improve timely documentation.



Disclosures:


Quarshie Glover, MBChB¹, Mark Benson, MD², Kevin Patel, MD², Jennifer Weiss, MD, MS², Monica Zablotney, ARNP³, Jacqueline Stubbe, RN³, Brittney Kile, RN, MSN³, Taylor Gaffney, MBA³, Mathieu Ambrose, RN³, Deepak Gopal, MD, FACG². P1227 - Improved Timely Documentation and Chart Encounter Closure Rates With the Implementation of a Validated Quality Improvement Process in the Division of Gastroenterology and Hepatology, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.