Prevalence of Copied Information by Attendings and Residents in Critical Care Progress Notes*

Abstract

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.

Safe Practices for Copy and Paste in the EHR

“…For instance, Edwards et al reviewed a random sample of 239 outpatient primary care, cardiology, and endocrinology notes and found that 10.8% contained copied material (although a definition of copy and paste was not provided) [7]. Conversely, another study of ICU notes (A/P section) found that 82% of resident and 74% of attending notes contained copied elements (defined as ≥20% copied text from another document) [8]. Thielke et al (2006) [9] evaluated how often mental status, podiatry and general physical exams appeared to be copied.…”

Use of dictation as a tool to decrease documentation errors in electronic health records

“…One factor that might be contributing to this is the setting of our research, which only analyzed notes written by residents, compared to other studies, which also included attending physicians. One study done in a critical care setting found 74% copying among attending physicians and 82% among all the physicians in the medical critical care unit [14]. A study done in a Veterans Affairs hospital found the prevalence of copying to be 20% [16].…”

“…Implementation of EMR has led to an increase in the time spent completing notes, resulting in an increased use of the copy-and-paste function by physicians [13,14]. The last few years have seen an increased interest in the evaluation of EMR.…”

Bedside Diagnosis in the Intensive Care Unit. Is Looking Overlooked?

“…In 2006, 25% of electronic patient charts in a sample from the Veterans Affairs system contained a physical examination generated by copypaste (21). This problem has worsened: a more recent analysis suggests that threequarters of electronic notes written by critical care attendings contain greater than 20% copied information (22). We were unable to find reliable estimates as to the frequency of attesting to or copy-pasting a physical examination not personally performed, but such a practice would have clinical consequences, represent a lost teaching opportunity, and constitute fraudulent billing (23).…”