The Growing Use of Copy-Paste and Its Impact on Creation and Propagation of Documentation Errors.

Background: Electronic health records have introduced tools to improve administrative productivity, but they also pose challenges that may affect documentation accuracy and clinical decisions, especially in high-acuity patients. Research Question: What is the prevalence and evolution of copy-paste practices in daily progress notes within an ICU, and how do these practices influence the creation or propagation of documentation errors? Study Design and Methods: This retrospective cohort study analyzed progress notes written by residents and attendings in a medical ICU at a single academic center from 2017 to 2022, focusing on the use of copied content. A random sample of 180 resident notes was manually reviewed for clinical accuracy. Content sources and copy-related errors were examined for correlations with encounter characteristics and documentation burden. Results: At total of 60,127 notes were analyzed for composition trends. Over the study period, resident notes lengthened by 21%, with copied content increasing by 34% and direct and templated content decreasing by 52% and 9%, respectively. Attending note length increased by 2%, with no change in copied content. For residents, periods with more notes written per day correlated positively with note length, and proportion of templated and copied text but negatively correlated with direct text. Chart review of resident notes revealed copied text in all samples; one-half were from another author. A total of 521 documentation errors were identified, with errors of omission being the most common (61%), then commission (28%), and temporal errors (11%). Temporal errors correlated with elapsed stay and copied text. Interpretation: In our medical ICU, progress notes are getting longer, and longer notes are associated with increased use of passive documentation such as copied content. For residents, this behavior is exacerbated during times of increased documentation burden. Copied content introduces a mechanism for errors to be created and propagated, as evidenced by the documentation errors related to copy-paste identified in this study.