Hey guys, I have a couple more questions:
What's the most efficient sequence of events for admitting a patient? (computer chart)
Thanks
Like Gutonc suggested, you'll eventually figure out what works best for you. The advantage to EMR's is that there's a wealth of information at your fingertips. As Biggie once noted though, "mo' money mo' problems." You could easily get lost in their medical records.
Having worked as a hospitalist for 3 years (going on 4) at a very busy academic center, I've found that the following works the best for me.
Assuming they're being admitted from the ED or clinic, you have at least 15mins or more before they hit the floor. This is ample time to...
1. Look up their most recent Inpt H&P, Discharge Summary, and outpt clinic note. From this, I make a skeleton list of their PMH, med list, and social/family hx before I even lay eyes on them. By no means am I suggesting you cut and paste this part. I personally find it a lot easier to review EACH and EVERY item w/ the pt in order to confirm their accuracy and THEN ask the pt if there's anything I missed or left out. Trust me, it's a lot quicker to ask Mrs. Smith if her PMH includes ITP, COPD, CAD s/p 5V CABG, htn, and prior choly than it is to ask her "Any medical problems that you're aware of?" and "What medications are you currently taking?". The key is to make as much of your questions "yes/no" as possible when reviewing the PMH/Social hx/Family hx/med list. Open ended questions are for the HPI.
2. Check to see what their main complaint in the ED was (sometimes the RN's document this in the RN notes before the ED doc note pops up). With the chief complaint in mind, review their labs/studies from the ED (I try not to read the radiology or ED reports to avoid bias).
3. If you still have time before they arrive on the floor, I would start typing up the PMH/Med list/Family Hx/Social Hx...you'll modify this later based on your conversation w/ the pt of course.
4. By now, you should have a decent idea of why they're here and what you might start doing to further their work-up. I would therefore start typing up my A/P (you know right off the bat if you're going to start symptomatic management such as IVF's, anti-emetics, pain control, etc).
5. See the pt.
6. Enter the most time sensitive orders first (basic admission orders, stat labs, IVF's, anti-emetics, etc)
7. Talk w/ your senior resident (+/- attending depending on your institution)
8. Enter the rest of your orders (Abx, additional imaging/labs, prophy)
9. Finish your H&P
10. Type up your signout
11. Rinse and repeat
Hope this helps! As you gain experience and confidence, a bread and butter pt should only take you 40-60mins from start to finish.