Scaffolding physician communication through a daily progress note redesign

This paper explores the design of the daily progress note, a medical document written daily to record a patient´s current status and clinical changes. The progress note is traditionally composed of four sections: subjective, objective, assessment and plan. At the start of this study, the original structure of the progress note did not mirror the verbal communication that takes place between physicians as they focus on the assessment and plan. Subject matter experts hypothesize that less experienced physicians find the subjective and objective sections of the note easiest to write and subsequently emphasize and spend more time filling out these sections. This study redesigned the structure of the progress note to prioritize the assessment and management plan as supported by the objective and subjective. This work was tested by the Division of Cardiology in the Department of Pediatrics at the University of Virginia. The redesigned note was evaluated using a data entry and presentation comparison as well as a simulated handoff. The results show that the progress notes are presented by reading the information from the top down and thus, the layout of the note should follow (and prompt) the desired flow of communication. Also, the use of prompts and more specific fields helps scaffold the documentation to better facilitate the verbal communication about patients between physicians.