Reducing Note Bloat: Streamlining a SOAP Note to Improve Information Flow at AMC

Presentation Description / Summary: Note bloat describes a medical note that contains unnecessary information obscuring critical or time-sensitive information. Said differently, note bloat is a dysfunction in medical information flow. To address the note bloat issue at the Schwarzman Animal Medical Center (AMC), the Chief Medical Officer convened a hospital wide committee to create a uniform medical note for the hospital. The committee developed a stakeholder survey, attended stakeholder meetings, and reviewed medical notes from AMC and other specialty hospitals. The committee also performed a literature review on issues leading to note bloat and studied legal, accreditation and educational requirements for medical notes. Based on the information obtained from their investigation, the committee concluded that the format of the current medical note template was less of a contributor to note bloat than how the template was being used. Stakeholders’ main concern about the current medical note was the difficulty of finding critical information in the medical note. These two findings prompted the committee to develop a medical note using a variation of the SOAP note called the APSO (Assessment, Plan, Subjective, Objective). To place the important information early in the note, the format was further modified to insert the diagnostic testing from that encounter first, creating a DAPSO (Diagnostic testing, Assessment, Plan, Subjective, Objective) format for the new medical note. The note is currently being implemented and outcomes from implementation will be included in the presentation.