(1328) Reducing Note Bloat in the Pediatric Intensive Care Unit

Introduction: Clinical notes are essential to patient care to document medical decision-making, facilitate hand-offs, and inform appropriate reimbursement. Notes have dramatically grown in length during the past decade, a phenomenon known as “note bloat.” Note bloat can decrease the readability of notes and increase provider dissatisfaction. We hypothesized that a standardized progress note template focused on clinically relevant information in our Pediatric Intensive Care Unit (PICU) would reduce note bloat and increase provider satisfaction.

Methods: A multidisciplinary group comprised of intensivists, informaticists, electronic health record analysts, and representatives from revenue cycle, coding, billing, clinical documentation integrity, and compliance formed a task force to create a progress note template in our PICU. Baseline data from Epic© Signal, billing audits, and provider satisfaction surveys were collected in 2023. We aimed to decrease the average length of the progress note by 20% and increase provider satisfaction in reading and writing progress notes by 20%. Our balancing measure was to ensure that the time spent writing notes did not increase by more than 20%. The new note was implemented in January 2024. Six months post-intervention, data was recollected and compared to baseline.

Results: After the intervention, the median note length was 4,497.5 characters (IQR = 355), a 43% reduction from the baseline of 7,890 characters (IQR = 903). The internal survey had a 100% response rate pre-intervention and 93% post-intervention. Satisfaction with the time spent and efficiency of writing daily progress notes increased from 21% to 77% post-intervention. Satisfaction with the readability of notes increased from 7% to 77% for internal survey respondents and from 40% to 46% for external survey respondents. The median time spent writing notes increased by 14%, from 7 to 8 minutes per patient per day.

Conclusions: Creating a new note template to combat note bloat reduced note length and improved satisfaction with reading and writing progress notes. The small increase in time spent writing notes may reflect an adjustment period to the new template, inconsistent adoption, and greater attention to concise note writing. This work should be expanded to other note types and across disciplines.