LAUSR

T he study published by Weber et al. 1 describes the development of a novel tool for assessing trainee admission notes. Proper documentation of patient care is critical to daily practice, the literature describing “best practices” for admission note documentation is sparse, and assessing trainee note quality is challenging without a standardized, validated tool that can be practicably applied. The authors used an iterative, consensus approach to develop the “Admission Note Assessment Tool” (ANAT). The tool includes sixteen checklist items and two global assessment items (“document an initial hospital encounter” and “document clinical reasoning during an initial hospital encounter”), mapping them to sub-competencies of ACGME milestones. The ANAT had good inter-rater reliability (86–100%) for most checklist items. Inter-rater reliability (IRR) was lower for the assessment and plan checklist items (72–81%), and lowest for the global assessment items (69% and 68%). In spite of the limited IRR for more complex and global assessment items, the tool has several attractive features. First, orientation to ANAT requires only one hour. Second, notes could be assessed quickly. On average, supervising physicians needed 11.2 min to complete, versus 12.6 min for nonsupervising reviewers. Third, score agreement between the ratings of supervising and non-supervising physicians was good. Because individual items also map to sub-competencies, supervising physicians—or trained non-supervising reviewers who are overseeing residency-training programs—could reasonably use the tool regularly to assess the quality of trainees’ admission notes, to identify specific deficiencies, and to track progress over time. Additional tool strengths are (1) inclusion of an assessment of billing criteria (a unique feature); (2) applicability regardless of the specific electronic health record; and (3) allowance for narrative comments that are critical for giving trainees the specific feedback they need to improve documentation. The authors note that existing tools (PDQI-9 and RED checklist) require review of additional information apart from the note being reviewed. 4 The RED checklist is time efficient but designed for progress (not admission) notes. While ANAT appears promising from these results at one institution, further study is critical to determine whether ANAT should become the “gold standard” for assessing admission note documentation.