What is/was the charting time frame in your program?

[DeadCactus]

What was the written policy on turn around time for chart completion? What was actually done in practice? What kind of charts did you have?

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[SoCuteMD]

Rule was before you left your shift. We were t-sheets and then electronic, but the rule was the same either way.

 

[coachB]

What was the written policy on turn around time for chart completion? What was actually done in practice? What kind of charts did you have?

Paper charts. You didn't leave without being done.

 

[emergentmd]

My goal coming into a shift is to leave as soon as the next guy comes in. We do electronic charting and when its really busy, we take it home and do it from home. Sucks, but I rather do that with a beer than spend another second in the ED after a long shift.

We are "supposed" to finish within 24 hrs. People who bring it home tend not to finish everything within 24 hrs. When I have been really busy at home, I would delay for 3 dys at most b/c after that, charting is poor. The key is not to be an outlier. If you are going to finish after the specified time, don't do it so often as be the outlier.

 

[TooMuchResearch]

What was the written policy on turn around time for chart completion? What was actually done in practice? What kind of charts did you have?

Officially, I think we're supposed to finish everything before we leave. Some of our seniors have mastered finishing up by the end of the scheduled shift. Many of the rest of us end up staying late. Unofficially, we get notes done on admits, especially the sicker ones, asap. For the rest, well, lets just say we usually know how many days behind the coders are running. I'm usually done with some post-shift charting time. When things go to h*ll on shift, I do the critical charts and know our current estimates for the coders. We're all digital.

It's tough to keep caught up on notes with 20 in the waiting room and attendings pushing us to move patients up or out.

 

[Raryn]

The policy at our institution is for the ED residents notes to be done within a week. it's not uncommon to see notes not done 2 weeks+ on patients who we admit though.

 

[deleted547339]

That is crazy. How do you not finish your notes contemporaneously? Seems like it would be a big legal risk finishing your charts later. On a good day, I leave right on time; on a bag day, I leave an hour late. Most shifts I leave about 20 minutes after.

 

[filhodeinferno]

What was the written policy on turn around time for chart completion? What was actually done in practice? What kind of charts did you have?

Our program wants us officially to have them done before we leave. Unofficially we get about 24 hours or so before the staff/coders would know they're not done and ask us for them.

I usually just go home after the shift ends and spend a few hours getting it all done.

BTW....charting is he bane of my existence. I just can't help but think of how much more pleasant my life would be if I didn't have to chart. It's ridiculous how much time we spend in front of a computer vs in front of actual patients. Such is the life, I guess...

 

[Birdstrike]

Finish and e-sign after each patient. Never get more than 3 charts behind in only extreme circumstances and don't leave a shift before finishing all charts.

You staying late 2 hr to finish charts everyday (or charting at home) is a classic way of getting you to work 11 hr, and getting you to accept only 9 hr pay.

 

[filhodeinferno]

Finish and e-sign after each patient. Never get more than 3 charts behind in only extreme circumstances and don't leave a shift before finishing all charts.

You staying late 2 hr to finish charts everyday (or charting at home) is a classic way of getting you to work 11 hr, and getting you to accept only 9 hr pay.

Very true. As a chart monkey resident I put up with it. 2 hours after shift as an attending will be unacceptable to me.

 

[Birdstrike]

Very true. As a chart monkey resident I put up with it. 2 hours after shift as an attending will be unacceptable to me.

Yeah. The last ED group I worked with, "Super Fast Guy" always amazed us that he could see 20% more patients than everyone else, every shift. Well, it turns out he was doing 2 hrs of electronic T-Sheets at home, every shift. He wasn't really seeing 20% more patients. He was working 20% longer. It's not worth it, in my opinion.

 

[winkleweizen]

We all finish them before we go home. I'm surprised to hear this isn't the same elsewhere. I'm usually out on time but we have some who leave late almost every shift.

 

[namethatsmell]

Similar to many above, we need to finish all our charts before we leave. Moreover if you're more than 3-4 charts behind during the shift attendings will give you flak unless the place is melting down.

I moonlight at a shop where a few docs save all their charting until the end and wind up with 20+ charts to dictate--looks about as much fun as a shotgun blast to the face.

 

[TooMuchResearch]

What is the staffing (I.e. beds per resident/pa/whoever) in some of these places where everyone stays caught up on shift?

Every time it seems like I might have a bit of chart time, our arrival curve somehow dumps on me. Even if we're full and I'm waiting on results, they just push bedded patients or new patients to hallways and suddenly four more to be seen. If I don't get up immediately to see the new ones, either the attendings ask when I'm going to see them or the nurses or techs come by every couple of minutes to tell me what they already wrote in the chart or ask when I'm going to see bed 4/5/6/7.

 

[namethatsmell]

What is the staffing (I.e. beds per resident/pa/whoever) in some of these places where everyone stays caught up on shift?

Every time it seems like I might have a bit of chart time, our arrival curve somehow dumps on me. Even if we're full and I'm waiting on results, they just push bedded patients or new patients to hallways and suddenly four more to be seen. If I don't get up immediately to see the new ones, either the attendings ask when I'm going to see them or the nurses or techs come by every couple of minutes to tell me what they already wrote in the chart or ask when I'm going to see bed 4/5/6/7.

This happens a lot to me too (probably like many residents out there) and my advice is to have at least their h&p done by the time I've got the new patients orders in. Much easier/less painful to quickly write up the mdm as things are in progress.

Another tip I've learned is to use the computers on wheels if your shop has them. After I see a pt I leave their room and park myself with the computer in a random part of the dept and quickly chart them up. The nurses don't know to find me there and it's so much faster and easier to do it without interruptions.

 

[winkleweizen]

What is the staffing (I.e. beds per resident/pa/whoever) in some of these places where everyone stays caught up on shift?

Every time it seems like I might have a bit of chart time, our arrival curve somehow dumps on me. Even if we're full and I'm waiting on results, they just push bedded patients or new patients to hallways and suddenly four more to be seen. If I don't get up immediately to see the new ones, either the attendings ask when I'm going to see them or the nurses or techs come by every couple of minutes to tell me what they already wrote in the chart or ask when I'm going to see bed 4/5/6/7.

We have two residents for 12 to 16 beds. A lot of times the second resident is usually off service or an intern so they don't see as many

 

[RuralEDDoc]

At my program we needed to be done charting within 30 mins of each shift (for ACGME reasons, as we did primarily 12 hour shifts). That meant slowing down the last two hours of your shift to catch up on charting.
Someone mentioned charting the H&P at a random, hidden computer when you finish seeing a patient. This is smart. I find that people (nurses, techs, etc) have no problem interrupting you for non-urgent issues if they see you in person, but will tend to only call you for urgent issues. Find your hiding spots so you minimize non-urgent interruptions. (eg "Dr. Rural I had a question, my cousin has this rash *shows terrible iPhone pic* what do you think about it?")

 

[hundreddaysoff]

I'm an intern at a busy academic program. Officially we have 4 hours to chart admitted pts and 24 hours to chart discharged pts before admin starts bugging us. Most of us finish all our charting before leaving by staying ~1hr after shift, but there are a few stragglers that make the PD pretty vocal about these deadlines.

Charting is not the main thing that keeps me 1--2 hours late at this point. I can usually crank out at least an H&P after seeing each pt by willfully ignoring the unclaimed pts piling up on the tracker for a few minutes. My rate-limiting step at sign-out time is waiting for other people to finish stuff (test results, imaging, callbacks, attending consultation, stroke pt back from MRI to reevaluate) so that I can officially dispo all my pts and give straightforward sign-out to the next intern. Maybe I'm a masochist, but I feel like it'd be poor practice to sign out with something like "wait for referring physician to call back so we can understand why this pt is actually here".

 

[Tiger26]

I don't leave the hospital until my charts are done--make it a habit to get started immediately after you leave the room. That way you can at least get the HPI and exam done and then can fill in the rest later.

 

[TooMuchResearch]

I'm an intern at a busy academic program. Officially we have 4 hours to chart admitted pts and 24 hours to chart discharged pts before admin starts bugging us. Most of us finish all our charting before leaving by staying ~1hr after shift, but there are a few stragglers that make the PD pretty vocal about these deadlines.

Charting is not the main thing that keeps me 1--2 hours late at this point. I can usually crank out at least an H&P after seeing each pt by willfully ignoring the unclaimed pts piling up on the tracker for a few minutes. My rate-limiting step at sign-out time is waiting for other people to finish stuff (test results, imaging, callbacks, attending consultation, stroke pt back from MRI to reevaluate) so that I can officially dispo all my pts and give straightforward sign-out to the next intern. Maybe I'm a masochist, but I feel like it'd be poor practice to sign out with something like "wait for referring physician to call back so we can understand why this pt is actually here".

Some of those things are easily signed out. Figure out what you're going to do with your pending results and sign out that plan. If troponin negative, then (blank). If MRI anything, then still admit because it's a stroke.

 

[Pons Asinorum]

The policy at our institution is for the ED residents notes to be done within a week. it's not uncommon to see notes not done 2 weeks+ on patients who we admit though.

I don't get this one. I'm just getting started at this note-actually-mattering thing but our policy is officially 24 hrs, with some attending variability. I guess my confusion is are your attendings waiting 2+ weeks to drop attestation notes, and aren't the billing/coders freaking out by 2 weeks? For a lot of admit patients, it seems to be a billing race who can bill for what parts of the patients care/work up. Not being complete for coding would seem to leave an opening for billing to bleed away to admitting teams.

 

[Angry Birds]

I knew a senior resident who graduated and had been an attending in an another state for two years, and we would joke, "She is still finishing up her charts [from residency]."

(Don't be that resident.)

But, I agree with the idea of not being the outlier. I remember my program demanded all charts done before you leave the hospital. I generally did that but on those evening shifts where I was already 1-2 hours post-shift, I'd give two middle fingers to the man and just take my sweet time finishing the charts.

Also, I made sure to get charts done ASAP for my program director and EM chair and anyone else important.

 

[Angry Birds]

I'm an intern at a busy academic program. Officially we have 4 hours to chart admitted pts and 24 hours to chart discharged pts before admin starts bugging us. Most of us finish all our charting before leaving by staying ~1hr after shift, but there are a few stragglers that make the PD pretty vocal about these deadlines.

Charting is not the main thing that keeps me 1--2 hours late at this point. I can usually crank out at least an H&P after seeing each pt by willfully ignoring the unclaimed pts piling up on the tracker for a few minutes. My rate-limiting step at sign-out time is waiting for other people to finish stuff (test results, imaging, callbacks, attending consultation, stroke pt back from MRI to reevaluate) so that I can officially dispo all my pts and give straightforward sign-out to the next intern. Maybe I'm a masochist, but I feel like it'd be poor practice to sign out with something like "wait for referring physician to call back so we can understand why this pt is actually here".

That's what sign-out is for.

It's better to give a clean and organized sign-out at sign-out time than to stick around 1 hour past your shift. Just my opinion.

 

[TooMuchResearch]

That's what sign-out is for.

It's better to give a clean and organized sign-out at sign-out time than to stick around 1 hour past your shift. Just my opinion.

Exactly. If it's something that will take you a couple of minutes, like discharge, then give a one liner and say you're discharging now.

You know the plan and possible outcomes when you order tests, sign out that plan.

It is much worse for the receiver to get additional sign out an hour after sign out.

 

[Angry Birds]

Exactly. If it's something that will take you a couple of minutes, like discharge, then give a one liner and say you're discharging now.

You know the plan and possible outcomes when you order tests, sign out that plan.

It is much worse for the receiver to get additional sign out an hour after sign out.

Agreed. And, word to the wise (i.e. the intern who posted), it will make you look disorganized if you routinely stay past your shift to "clean up." Sign out happens every single day at the exact same time. I am always surprised at how some residents/attendings are always so bewildered that sign-out time has arrived. At least one hour before sign-out there should be an alarm that goes off in your head, i.e. what do I need to do in the next hour to give a clean sign-out? Then another alarm at the 30 minute mark and another at the 15 minute mark. You do the best you can in that time--and the rest you sign out. Personally, I work extremely hard during that last hour in order to tidy up, but if the buzzer goes off (i.e. sign-out), I'm going to sign out and bounce before stuff that was pending comes back. The absolute worst is when ten minutes AFTER sign out, someone says, "Oh, the CT scan result is back... Do you want to just discharge the patient yourself?"

Conversely, I would never ask an outgoing resident to do that. That resident must be tired and wiped out. They just gave their entire soul and every fiber of their being working way harder per unit of time than any other specialty in medicine (and only someone who does our job full time as either a senior resident or attending can know this)... So if by the time sign out is done and the CT scan just came back, I'll just keep it to myself, review the patient's H&P, the labs and CT scan results, and then go talk to the patient, dispo-ing them myself.

Just my opinion. I know others may differ in this.

 

[EM4life]

Our official rule is 24 hours to finish charts, I can tell you that I often find myself going more than a day however (I'm not an outlier) mostly because I write rather specific/detailed notes. I do prioritize my charting for sick/admitted patients, and then the high risk complaints or potential bouncebacks and then leave the easiest nonsick for last. If all else fails, I will prioritize my charting of the oldest patient to the youngest haha, it's a weird system but it works for me and keeps me sane when there is a mountain of charts and I don't know where to start.

 

[Raryn]

I don't get this one. I'm just getting started at this note-actually-mattering thing but our policy is officially 24 hrs, with some attending variability. I guess my confusion is are your attendings waiting 2+ weeks to drop attestation notes, and aren't the billing/coders freaking out by 2 weeks? For a lot of admit patients, it seems to be a billing race who can bill for what parts of the patients care/work up. Not being complete for coding would seem to leave an opening for billing to bleed away to admitting teams.

I'm an IM resident, so I can only primarily speak to what I observe the patients we get admitted. A bit over half of the patients that we admit have ED notes written within the first 24 hours, half of the remainder within 2-3 days, and the remaining quarter at random times anywhere up to 7-10 days out. I've seen patients on hospital day #14-16 with a note still pended by the ED resident, though that's gotten less common in the last few years. When I've asked them, they said that their policy is they have up to a week.