Education Research: Exploring the Impact of Standardized, Condition-Specific Note Templates on Quality Metrics and Efficiency in Multiple Resident Clinics

Background And Objectives: Electronic health record documentation burden negatively affects physician satisfaction and patient care. Although well-constructed notes are important for care quality and safety, most note templates are created and maintained by individual physicians, leading to inefficiency and variable note quality. This study aimed to assess whether standardized, condition-specific note templates could enhance the efficiency and quality of notes written by neurology residents in the outpatient setting.

Methods: In a quality improvement study with a randomized, nonblinded design from July 2021 to June 2022, neurology residents were assigned standardized templates for epilepsy, headache, and Parkinson disease (PD) in 2 outpatient clinics. The standardized templates were created with input from specialists in these disorders. Efficiency was gauged based on the time and characters involved in note writing while quality was assessed by adherence to American Academy of Neurology quality metrics for each condition through chart review. A qualitative survey gathered resident opinions on the templates. Linear regression models were used in the efficiency and quality analyses.

Results: The study included 23 of 34 neurology residents. Templates were used in 36% of eligible encounters over the first 6 months of the study and 65% over the last 6 months. No significant difference in time spent on note writing was observed between the template and nontemplate groups. While both groups showed similar quality measures across most domains, the template group documented quality measures more consistently for driving status in epilepsy (92% vs 53%, = 0.002), medication-related motor symptoms in PD (95% vs 50%, = 0.01), and lifestyle changes in headache management (77% vs 21%, = 0.005). Resident feedback suggested that the templates facilitated clinic workflows and prompted more thorough patient inquiry.

Discussion: Standardized, condition-specific templates improved documentation of quality metrics without increasing time spent. Despite initial low uptake of template use, an increase was observed over time, indicating potential for wider acceptance with implementation efforts. These templates, updated and maintained by subject matter experts, serve as an opportunity to incorporate quality care checklists and knowledge into a clinician's workflow. This warrants further research into template implementation and its effects on care quality and education for neurologists and generalists.