Developing and Testing a Framework to Assess Documentation Utility

Abstract

Clinical documentation workflows have been a challenge for many years, spurring a continued need for documentation burden assessment and mitigation practices. Understanding what clinical documentation is useful is becoming increasingly important to discern which documentation practices should be implemented and which should be discontinued. Our overall objective of this work was to ascertain succinct domains of documentation utility and apply them to a real-world scenario to assess their usefulness. To do so, we used pressure injury prevention documentation generated by nurses as the exemplar. First, we conducted qualitative interviews with nurses to explore the applicability of our four documentation utility domains: positive patient outcome promotion, promote behavior change, functional and legal requirements, and workflow usefulness. From these interviews, we expanded upon the initial domains to better inform our quantitative measurement of documentation utility within current practices. To quantitatively assess documentation utility, we used data from a recently changed documentation workflow regarding pressure injury prevention. Differences were not detected in pressure injury rates (p=.831), but we did detect some significance in turn and mobility documentation frequency. We further assessed nursing documentation in the context of other typical variables and constructed a Cox Proportional Hazard Model with LASSO variable selection which retained several nursing documentation variables. This thesis opens further opportunities to study documentation utility and burden reduction within different domains.