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THE JULY EFFECT: ARE THERE MORE CHARTING ERRORS IN JULY?
S Ratnapalan, J Cohen, P Cieslak, W Mounstephen
The Hospital for Sick Children, University of Toronto
BACKGROUND: The Emergency Department at the Hospital for Sick Children is the only dedicated paediatric emergency department in the city of Toronto and 380-400 trainees rotate through the department annually. Currently there are orientation packages; orientation sessions and a web based orientation available for trainees to teach accurate and proper charting of emergency records. July is the beginning of the academic year for trainees and is usually perceived as the most chaotic period in hospitals.
OBJECTIVE: The objective of this study is to assess charting errors by junior trainees (medical students, first and second year residents at the end of the academic year during their first week in the emergency department and compare them to the error rates at the beginning of the academic year July.
METHOD: Emergency patient records were reviewed in June 2006 and July 2006 in the first week of new trainee rotations to identify charting errors. The errors that were scored were:
Completion of time in to see patient/time of discharge; Documentation of the name of supervisor; Time and signature of medication orders; Documenting condition on discharge; Documenting weight on Physician ED record For each correct entry the trainee got 2 points. If there were no orders for the patient then the scores were out of 8. Data on level of the trainee and whether they had worked in the ED previously were also collected.
RESULTS: There were 129 charts from 12 trainees in June and 122 charts from 11 trainees in July.
Multivariable linear regression was completed to determine if there was a significant association between error rate and trainee level or month The average charting error rate for July 23.6% was significantly higher than the 16.8 % error rate in June (2.39 vs. 1.68, p=0.0041) There was no significant difference between error rates and trainee level (medical students versus residents). There were 5 medical students in June and none in July; one trainee had worked at the ED previously in June and 3 in July.
CONCLUSION: There seem to be a significant increase in charting errors by junior trainees in July, the beginning of the academic year when compared to June, the end of the academic year. The charting error rate does not seem to be affected by the level of training.