Charting errors in a teaching hospital.

OBJECTIVE: The objective of this study was to assess charting errors by junior trainees in the emergency department at the beginning of the academic year and to evaluate the effect of audits and reminders in reducing charting errors in July. METHODS: Medical records from June and July 2006 were reviewed to identify incomplete documentations (charting errors) in 5 areas. The audit was repeated in July 2007 after sample charts were displayed, and reminders were sent. RESULTS: There were 129 patient records completed by 12 trainees in June 2006 and 122 by 11 trainees in July 2006. The mean charting error rate for July (24%) was significantly higher than that in June (17%) (P = 0.0041). The mean charting error rate reduced to 14% after the intervention in July 2007. CONCLUSIONS: There is a significant increase in charting errors by new trainees in July compared with June. A simple intervention of reminders and alerts significantly reduced charting errors in July.

Physicians' perceptions of background noise in a pediatric emergency department.

OBJECTIVE: The objectives of this study were to measure noise levels in a tertiary care pediatric emergency department (ED) and to identify attending staff physicians' and first-year residents' perceptions of background noise levels and its impact on communication and teaching. METHODS: A mixed methodology was used in this study. A sound level meter measuring 30 to 140 dB was placed in the ED for a week. All consenting staff physicians and first-year residents were surveyed using a semistructured questionnaire during the study period to assess their perceptions of background noise and its impact. Descriptive statistics were used for quantitative analysis. Narrative answers were coded and analyzed using the method of meaning condensation to assess the impact of background noise on both communication and teaching. RESULTS: The average noise level in the ED is 68.73 dB for a 24-hour period. The number sound peaks higher than 80 dB, with an average of 309 dB/d (minimum, 193 dB; maximum, 461 dB). Only 35% of staff physicians' surveys and 22% of residents' surveys identified the noise levels to be uncomfortable. However, background noise in the ED was perceived as stressful, affecting interaction, communication, and teaching between residents and staff physicians. Staff physicians and residents stated that they feel helpless when it is too noisy and did not have good strategies to reduce background noise in the ED. CONCLUSIONS: The high background noise levels in a pediatric ED are perceived as stressful and interfering with communication and teaching. Noise levels in EDs should be measured, and noise reduction strategies should be implemented because physicians are not consistent in identifying excessive noise levels.