New Coding Guidelines Reduce Emergency Department Note Bloat But More Work Is Needed

Abstract

Study objective: The length and redundancy of notes authored by clinicians has significantly increased, giving rise to the term "note bloat." We analyzed the impact of new coding guidelines and documentation best practices on the length of emergency department (ED) notes and the amount of time clinicians spent documenting.

Methods: In a large, multisite health care delivery organization, we retrospectively evaluated the length of all ED provider notes and the amount of time clinicians spent documenting between February 2018 and June 2023. In January 2023, we implemented changes to the standardized note template to align with the new coding guidelines from the American Medical Association and the Centers for Medicare & Medicaid Services. The primary outcomes were the length of provider notes and the amount of time spent documenting.

Results: Our study sample consisted of 1,679,762 ED provider notes. Six months after the intervention, the average note length decreased by 872 words (95% confidence interval 867 to 877 words), whereas the amount of time clinicians spent documenting did not change.

Conclusions: Embracing new guidelines and practices, we reduced the length of ED provider notes by 872 words. Despite this, the time clinicians spent documenting did not change significantly. We provide an early report of success in reducing note bloat in the ED to help guide future efforts to reduce overall documentation burden.