Appl Clin Inform 2017; 08(03): 981-993
DOI: 10.4338/ACI2017050080
Research Article
Schattauer GmbH

The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine

Katherine J. Walker
1  Emergency Department, Cabrini Hospital, Melbourne, Australia
4  Monash University, Department of Epidemiology and Preventative Medicine, Melbourne, Australia
,
Andrew Wang
2  Cabrini Institute, Melbourne, Australia
3  Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
,
William Dunlop
1  Emergency Department, Cabrini Hospital, Melbourne, Australia
,
Hamish Rodda
1  Emergency Department, Cabrini Hospital, Melbourne, Australia
5  Box Hill Hospital, Melbourne, Australia
,
Michael Ben-Meir
1  Emergency Department, Cabrini Hospital, Melbourne, Australia
,
Margaret Staples
2  Cabrini Institute, Melbourne, Australia
4  Monash University, Department of Epidemiology and Preventative Medicine, Melbourne, Australia
› Author Affiliations
Funding The Cabrini Medical Staff Association funded AW. The Phyllis Connor Memorial Fund, Equity Trustees, the Cabrini Institute, Foundation and hospital also funded this work. No input was provided into study design or write-up by funders.
Further Information

Publication History

received: 17 May 2017

accepted in revised form: 02 August 2017

Publication Date:
20 December 2017 (online)

Summary

Background: Scribes are assisting Emergency Physicians by writing their electronic clinical notes at the bedside during consultations. They increase physician productivity and improve their working conditions. The quality of Emergency scribe notes is unevaluated and important to determine.

Objective: The primary objective of the study was to determine if the quality of Emergency Department scribe notes was equivalent to physician only notes, using the Physician Documentation Quality Instrument, Nine-item tool (PDQI-9).

Methods: This was a retrospective, observational study comparing 110 scribed to 110 non-scribed Emergency Physician notes written at Cabrini Emergency Department, Australia. Consultations during a randomised controlled trial of scribe/doctor productivity in 2016 were used. Emergency physicians and nurses rated randomly selected, blinded and de-identified notes, 2 raters per note. Comparisons were made between paired scribed and unscribed notes and between raters of each note. Characteristics of individual raters were examined. The ability of the tool to discriminate between good and poor notes was tested.

Results: The PDQI-9 tool has significant issues. Individual items had good internal consistency (Cronbach’s alpha=0.93), but there was very poor agreement between raters (Pearson’s r=0.07, p=0.270). There were substantial differences in PDQI-9 scores allocated by each rater, with some giving typically lower scores than others, F(25,206)=1.93, p=0.007. The tool was unable to distinguish good from poor notes, F(3,34)=1.15, p=0.342. There was no difference in PDQI-9 score between scribed and non-scribed notes.

Conclusions: The PDQI-9 documentation quality tool did not demonstrate reliability or validity in evaluating Emergency Medicine consultation notes. We found no evidence that scribed notes were of poorer quality than non-scribed notes, however Emergency scribe note quality has not yet been determined.

Citation: Walker KJ, Wang A, Dunlop W, Rodda H, Ben-Meir M, Staples M. The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine. Appl Clin Inform 2017; 8: 981–993 https://doi.org/10.4338/ACI2017052017050080

Human Subject Protections

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was approved by Cabrini Human Research Ethics Committee (06–27–07–15).


Contributions

KW, MS, WD, HR and AW conceived the study and designed the trial. KW, AW: ethics. KW, MBM: funding. AW recruitment, randomization, database design. KW: data collection. MS, WD: statistics, data analysis. AW, WD, KW drafted manuscript. All authors contributed to its revision. KW takes responsibility for the manuscript.