title: Impact of a structured intern education programme on clinical documentation in the emergency department.
abstract: OBJECTIVE
  To evaluate the impact of More Learning for Interns in Emergency (MoLIE) on clinical documentation in the ED of a large regional hospital.
  
  
  METHODS
  MoLIE was implemented at The Townsville Hospital (TTH) in 2010, and has since provided ED interns with structured off-floor teaching and a dedicated clinical supervisor. A pre- and post-intervention study was conducted using retrospective medical record review methodology. Charts were selected by identifying all TTH ED patients seen by interns in the period 2008-2011. Two hundred pre-intervention records (2008-2009) and 200 post-intervention records (2010-2011) were reviewed. These were randomly selected following an initial screen by an ED staff specialist. The quality of clinical documentation for five common ED presentations (asthma, chest pain, lacerations, abdominal pain and upper limb fractures) was assessed. For each presentation, documentation quality was scored out of 10 using predefined criteria. An improvement of two or more was thought to be clinically significant. Mean scores for each group were compared using a Student's t-test for independent samples.
  
  
  RESULTS
  Mean documentation scores (and 95% confidence intervals) were 5.55 (5.17-5.93) in 2008, 5.42 (4.98-5.86) in 2009, 6.37 (5.99-6.75) in 2010 and 6.08 (5.71-6.45) in 2011. There was a statistically but not clinically significant improvement in scores pre- and post-intervention (P ≤ 0.001).
  
  
  CONCLUSIONS
  The introduction of MoLIE was associated with a small but statistically significant improvement in documentation, despite an 80% increase in intern placements. These results suggest that structured training programmes have potential to improve intern performance while simultaneously enhancing training capacity. The impact on quality of care requires further evaluation.
authors.affiliation: Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: McLean
authors.forename: Jenine
authors.initials: J
authors.lastname: Lawlor
authors.forename: Rob
authors.initials: R
authors.lastname: Mitchell
authors.forename: David
authors.initials: D
authors.lastname: Kault
authors.forename: Carl
authors.initials: C
authors.lastname: O'Kane
authors.forename: Michelle
authors.initials: M
authors.lastname: Lees
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D001249:Asthma / Q000175:diagnosis; D002637:Chest Pain / Q000175:diagnosis; D054869:Clinical Audit; D004282:Documentation / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis; D006801:Humans; D007396:Internship and Residency; D022125:Lacerations / Q000175:diagnosis; D008297:Male; D008499:Medical Records / Q000592:standards*; D012189:Retrospective Studies
keywords: education; emergency; medical; medicine