Objective To determine the prevalence and mechanism of copying among ICU physicians using an electronic medical record. Design Retrospective cohort study Setting Medical intensive care unit of an urban, academic medical center Participants 2,068 progress notes of 135 patients generated by 62 resident and 11 attending physicians between August 1 and December 31, 2009. Interventions None Measurements and Main Results 82% of all resident and 74% of all attending notes contained ≥20% copied information (p=.001). Although residents authored more copied notes than attendings, residents copied less information between notes than attendings (55% vs. 61%, p<.001). Following ≥1 day off, residents copied less often from their own prior notes compared to attendings (66% vs. 94%, p < .001). Of the copied information following a day off, there was no difference in the amount of information copied into notes of residents (59%) or attendings (61%, p =.17). In a fixed effects regression model of attending notes, no patient factors were associated with copying. However, the levels of copying among attendings varied from 41% to 82% (p < .001). Conclusions Copying among attendings and residents was common in this ICU-based cohort, with residents copying more frequently and attendings copying more information per note. The only factor that was independently associated with attending copying was the attending. Further studies should focus on further elucidating the factors influencing copying in the ICU and the effects of copying on patient outcomes.

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Background: The interval between inpatient hospitalization for symptomatic coronary artery disease (CAD) and post-discharge office consultation is a vulnerable period for adverse events. Methods: Content was customized on a smartphone app-based platform for hospitalized patients receiving percutaneous coronary intervention (PCI) which included education, tracking, reminders and live health coaches. We conducted a single-arm open-label pilot study of the app at two academic medical centers in a single health system, with subjects enrolled 02/2018À05/2019 and 1:3 propensity-matched historical controls from 01/2015À12/2017. To evaluate feasibility and efficacy, we assessed 30-day hospital readmission (primary), outpatient cardiovascular follow-up, and cardiac rehabilitation (CR) enrollment as recorded in the health system. Outcomes were assessed by Cox Proportional Hazards model. Findings: 118 of 324 eligible (36¢4%) 21À85 year-old patients who underwent PCI for symptomatic CAD who owned a smartphone or tablet enrolled. Mean age was 62.5 (9¢7) years, 87 (73¢7%) were male, 40 of 118 (33¢9%) had type 2 diabetes mellitus, 68 (57¢6%) enrolled underwent PCI for MI and 59 (50¢0%) had previously known CAD; demographics were similar among matched historical controls. No significant difference existed in all-cause readmission within 30 days (8¢5% app vs 9¢6% control, ARR -1.1% absolute difference, 95% CI -7¢1À4¢8, p = 0¢699) or 90 days (16¢1% app vs 19¢5% control, p = 0.394). Rates of both 90-day CR enrollment (HR 1¢99, 95% CI 1¢30À3¢06) and 1-month cardiovascular follow up (HR 1¢83, 95% CI 1¢43À2¢34) were greater with the app. Weekly engagement at 30-and 90-days, as measured by percentage of weeks with at least one day of completion of tasks, was mean (SD) 73¢5% (33¢9%) and 63¢5% (40¢3%). Spearman correlation analyses indicated similar engagement across age, sex, and cardiovascular risk factors. Interpretations: A post-PCI smartphone app with live health coaches yielded similarly high engagement across demographics and safely increased attendance in cardiac rehabilitation. Larger prospective randomized controlled trials are necessary to test whether this app improves cardiovascular outcomes following PCI.

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