P1240 - Implementation of a Smart Text Post-Procedure Note Template Improves Communication of Inpatient Endoscopic Recommendations: A Quality Improvement Study

Daniel Kats, MD¹, Benjamin Chipkin, MD, MS², Samantha Magier, MD, ME¹, Darrick K. Li, MD, PhD³, Michelle L. Hughes, MD³, Amy Ogurick, MD^3
1Yale-New Haven Hospital, New Haven, CT; ²Yale University School of Medicine, New Haven, CT; ³Yale School of Medicine, New Haven, CT

Introduction: Patient handoffs are known, high-risk opportunities for medical error, and thus communication between inpatient gastroenterologists (GI) and primary medical teams post-endoscopy is essential to ensure patient safety and appropriate clinical care. We previously developed a template that optimized post-procedure documentation by GI, and we further adapted this template with automation to evaluate whether this impacted direct patient care outcomes. We aimed to improve post-procedure documentation and implementation of recommendations related to diet, anticoagulation (AC), proton pump inhibitors (PPI) and antiplatelet agents (APT).

Methods: A retrospective cohort study of adults who underwent inpatient endoscopic procedures during pre-selected 1-week intervals from 2020 to 2022 was performed at a large academic center. A standardized, smart text, post-procedure brief operative note was developed and implemented in 2021 and refined with education provided in 2022. Two-tailed Chi-square tests and Wilcoxon rank sum tests were used to compare metrics between the pre- and post-template intervention. The primary process measures were completeness of consultant relevant documentation and time to post-procedure documentation, and primary outcome measures were time for primary team to place relevant order recommendations.

Results: 157 inpatient endoscopic procedures were included pre- and 163 cases post-intervention. As seen with intervention of the original template, there remained significant increase in the process measures including brief operative note use (50% vs. 91%, p < 0.001) and overall documentation of relevant clinical recommendations (38% vs 90%, p < 0.001), and a reduction in time to documentation (113 min vs. 31 min, p < 0.001). There was no significant improvement in the outcome measures of individual and overall order time for relevant recommendations.

Discussion: We re-demonstrated a marked improvement in timing and quality of post-procedure documentation through a templated, post-procedure brief operative note for GI. We were unable to demonstrate a significant change in time to order changes for these recommendations, though this does not reflect lack of implementation. Limitations include heterogeneity of patients and study design with unpaired cohorts. The optimal proxy of study success is improved time to documentation and completeness of recommendations, which can mitigate communication errors during critical, post-procedure handoffs.




Disclosures:


Daniel Kats, MD¹, Benjamin Chipkin, MD, MS², Samantha Magier, MD, ME¹, Darrick K. Li, MD, PhD³, Michelle L. Hughes, MD³, Amy Ogurick, MD³. P1240 - Implementation of a Smart Text Post-Procedure Note Template Improves Communication of Inpatient Endoscopic Recommendations: A Quality Improvement Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.