Quality improvement and practice-based research in sleep medicine using structured clinical documentation in the electronic medical record.

Background: We developed and implemented a structured clinical documentation support (SCDS) toolkit within the electronic medical record, to optimize patient care, facilitate documentation, and capture data at office visits in a sleep medicine/neurology clinic for patient care and research collaboration internally and with other centers.

Methods: To build our SCDS toolkit, physicians met frequently to develop content, define the cohort, select outcome measures, and delineate factors known to modify disease progression. We assigned tasks to the care team and mapped data elements to the progress note.

Traumatic brain injury-induced sleep disorders.

Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%-70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury.

Mystery case: a young boy with myoclonic jerks.

A 16-year-old right-handed boy presented for consultation for recent development of seizures. He is the product of a normal pregnancy and delivery without a history of developmental delay, head trauma, or family history of epilepsy. A year and a half prior to our consultation, the patient noted that his hand would suddenly jerk across the page while writing in his morning classes.