Improving the Physician Inbox Management in Electronic Health Record by a Multifaceted Bundled Intervention.

Abstract

Timely closure of patient encounters and addressing tasks in the Electronic Health Record (EHR) inbox are essential for quality care and efficiency. Delinquent items in the EHR inbox impact patient care, cost of care, and overall patient and provider experience. This project aimed to improve the management of these items using a quality improvement initiative with a bundled intervention. This study was conducted using a quasi-experimental method with interrupted time series. Stakeholders were engaged to define policies and expectations based on root cause analysis. Interventions included creating policy and procedures with clear expectations, creating resources, addressing inbox management delinquency using Just Culture with consoling, coaching, and disciplining. Simple rubrics using the situation-behavior-impact framework and motivational interviewing questions were used for coaching. Data were analyzed using JMP Pro 16 with statistical process control charts for phase analysis. Poisson regression was used to explore statistically significant trends after the implementation of the intervention bundle. The average number of open encounters decreased from 71 per week preintervention to 33.8 per week in the rollout period, and 12.2 per week postintervention. The phase analysis on individual moving range control chart showed a significant shift in the process after the implementation of the intervention. Poisson regression showed a 78% decrease in the number of delinquent items (P < 0.001) after the implementation of the bundled intervention. A multifaceted intervention significantly improved EHR inbox management with potentially positive impact on the quadruple aim.