ICU patients require a detailed, accurate daily assessment and plan for optimal care. We conducted a study to determine how a well organized, daily progress note can help the Housestaff understand the complex ICU issues, improve documentation, and optimize application of standard of care.
Residents in two affiliated institutions, a University hospital and a VA hospital, were observed for four months. During the first two months residents used their own or institution’s progress notes and presentation format. After two months a new standardized progress note was introduced and Housestaff was asked to present and document using the new format. Housestaff and Intensivists completed questionnaires assessing several areas during observation and intervention months. The survey included documentation of relevant data, application of ICU standards of care (daily discontinuation of sedation, GI and DVT prophylaxis), and presentation of problem list and plan.
Subjective evaluation by the Housestaff did not change in either arm, ranking themselves high regardless of intervention. Intensivists however, noticed significant improvement in identification and documentation of relevant data, presentation of assessment and plan, and application of certain ICU standards in patient care with the standardized progress note (Graph 1). Documentation and presentation areas which did not improve were the daily discontinuation of sedation and ventilator weaning.
Based on Intensivists’ evaluations, a standardized presentation format improves patient care in several areas. The poor performance and lack of improvement in some areas, such as daily discontinuation of sedation, highlights the need for additional attention from the intensivists, fellows and senior residents. A larger study with evaluation of objective data is needed to more accurately confirm these results.
We believe this is the first study assessing the impact of a standardized presentation format in applying well established ICU standards in patient care. We demonstrated that such a format improves documentation, presentation, and therefore likely patient care and teaching.
Javid Kamali, None.