Increasing the Percentage of Problem Lists Marked as Reviewed at Discharge.

Abstract

Objective: Problem lists (PLs) are key to ensuring patient safety, accuracy of documentation, and clear communication among providers within the electronic health record (EHR). However, PLs frequently remain out of date, lacking new diagnoses and retaining former or duplicate diagnoses. The aim of this project was to increase use of the PL by the pediatric hospital medicine (PHM) service by increasing the percentage of PLs marked as reviewed and updated at discharge while increasing accuracy of documentation in the PL.

Methods: Weekly data on all patients discharged from the PHM service was collected, and medical record audits were performed by the clinical documentation integrity team for accuracy. Initial interventions focused on incorporating the PL into the standard discharge workflow using EHR tools (including SmartPhrases and wildcards in the discharge summary) as well as education. Later, data transparency and value incentives for attendings were incorporated for attending engagement. Data were reported and analyzed on statistical process control charts.

Results: In 18 months, the centerline of the PL being marked as reviewed at discharge improved from 26% to 92%. For updating the PL at discharge, the centerline shifted from 44% to 91%. Accuracy increased from 40% to 64% during the first 8 months.

Conclusion: PL use, including updating the PL, marking the PL as reviewed, and accuracy of the PL can be improved through education, EHR interventions, transparency of data, and emphasis on quality metrics. Incorporating the PL into the discharge process using existing EHR tools can optimize documentation and standardize workflow around the PL.