Teaching and Maintaining Quality of Resident Inpatient Progress Notes:
Development of the Progress Note Quality Instrument
Abstract
Rationale, aims and objectives: Since the widespread implementation of
electronic medical records, there have been concerns about errors,
excessive copying forward, and reduced quality in resident inpatient
progress notes. The goal of this study was to create and validate a tool
to assess the quality of progress notes written on an inpatient
neurology service. Methods: A survey assessing perceptions of resident
inpatient neurology progress note quality was administered to faculty
and residents, and based on these results, a four item note assessment
tool (PNQIv2) was developed. The tool assessed the following attributes:
(1) accuracy, (2) synthesis, (3) focus, (4) patient-centeredness, and
(5) copied-forward material. 120 note reviews were completed by 4 study
investigators on 30 different resident progress notes utilizing 10 out
of 16 possible residents (62.5%). Mean PNQIv2 scores were calculated as
well as inter-rater reliability for the overall PNQIv2 scores and their
subsections using inter-class correlation coefficients and 95%
confidence intervals. Results: The PNQIv2 was found to have good
inter-rater reliability at 0.7 and was considered quick and simple to
use. The mean total PNQIv2 score was 9.2 (SD 2) out of 12. 60% of notes
were determined to be at least adequate quality by receiving a PNQIv2
score of ≥ 9, and 63% of notes contained at least 2/3 copied-forward
material. Conclusions: The investigators developed a progress note
assessment tool that was simple and practical to use on the wards, with
good inter-rater reliability, which may be useful to formally evaluate
the quality of resident inpatient progress notes.