Documentation Misery

[Interpolfanclub]

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Is anyone else as exasperated as I am by the amount of documentation we do? At my program we are now being urged to write "sign-over" notes on patients signed out to us and on patients we are signing over to on-coming residents in addition to the note we've already written on the patient.

Between doing this, documenting everything I am doing/discussing with my own patients, seeing patients with medical students and keeping an eye on the 30+ waiting room I don't feel like I ever do any real medicine. Does this drive anyone else crazy? How are you guys dealing with this documentation push? Do I document on every patient like it could go to court? Do I skimp on the documentation and spend more time at the bedside? I'm trying to do both as it is now but I don't know if it's sustainable.

The current state of EM where we are told never to miss anything but don't order too much, and oh by the way document everything you do but hurry up and see more patients is just unreasonable. Tks for the input.

 

[Jeff698]

Between doing this, documenting everything I am doing/discussing with my own patients, seeing patients with medical students and keeping an eye on the 30+ waiting room I don't feel like I ever do any real medicine.

Sadly, my friend, medicine doesn't get any more real than that.

This is the way of the future as dictated by Those Who Know, ie JCAHO, er JC, er whatever the hell they're calling themselves these days. These are self-perpetuating organizations who make themselves feel like they are improving health care by measuring things. It doesn't really matter much that what they're measuring doesn't matter.

Let's take the average tooth ache, er acute dental pain, that comes to my ED. They'll be met by a triage nurse who will interact with them for about 15 minutes, getting lots of information that has nothing to do with their tooth and putting it into a computer. Yes, they smoke. No, they didn't get their flu shot. Yes, they feel safe at home. No, there are no barriers to communication.

They then get taken into a room where I interact with them for, maybe, 2 minutes. They then wait while I do 6 minutes of paperwork describing the 2 minute visit.

Repeat this process 30-40 times in a 12 hour shift and see what percentage of your day is spent on things that actually matter to a patient's care.

And people wonder why health care costs so much and frustrates so many.

Take care,
Jeff

 

[MeBeAnEP]

I wonder if it would ever be feasible to have medical stenographers. Someone to sit in the exam room and record the H&P on computer. Then the doc would only have to worry about assessment and plan. Might cut down on some of the documentation time vacuum.

 

[Drawing Dead]

I wonder if it would ever be feasible to have medical stenographers. Someone to sit in the exam room and record the H&P on computer. Then the doc would only have to worry about assessment and plan. Might cut down on some of the documentation time vacuum.

Except someone will throw the dreaded "H" word out there, and that will nix that. We could do it with medical students though, since the are bound by the almighty "H" policy and are seeing the patient anyway.

 

[jbar]

some states have medical stenographers, don't know how H would apply
(assume this is HIPPA) since that person would just have to go through the same HIPPA training as anyone else. They wouldn't be much different from a unit secretary who sees patient charts.

 

[Doctor Bob]

I wonder if it would ever be feasible to have medical stenographers. Someone to sit in the exam room and record the H&P on computer. Then the doc would only have to worry about assessment and plan. Might cut down on some of the documentation time vacuum.

Back before medschool, I worked as an ER tech at a hospital that was a smaller hospital in a regional chain. At the mothership hospital the ER docs each had their own stenographer that would follow them around during the shift recording everything for them, writing down orders, etc. The one shift I worked over there made me jealous by-proxy for our docs at the smaller hospital who complained daily about the paperwork.

 

[WakeMedHeel]

I wonder if it would ever be feasible to have medical stenographers. Someone to sit in the exam room and record the H&P on computer. Then the doc would only have to worry about assessment and plan. Might cut down on some of the documentation time vacuum.

This already happens where it's economically feasible.

 

[AmoryBlaine]

Is anyone else as exasperated as I am by the amount of documentation we do? At my program we are now being urged to write "sign-over" notes on patients signed out to us and on patients we are signing over to on-coming residents in addition to the note we've already written on the patient.

Between doing this, documenting everything I am doing/discussing with my own patients, seeing patients with medical students and keeping an eye on the 30+ waiting room I don't feel like I ever do any real medicine. Does this drive anyone else crazy? How are you guys dealing with this documentation push? Do I document on every patient like it could go to court? Do I skimp on the documentation and spend more time at the bedside? I'm trying to do both as it is now but I don't know if it's sustainable.

The current state of EM where we are told never to miss anything but don't order too much, and oh by the way document everything you do but hurry up and see more patients is just unreasonable. Tks for the input.

This sounds like something I would just try not to do and see if you get away with it.

 

[GeneralVeers]

In medical school (Indiana) a local ER group would employ medicals students part time to see patients, do some of the documentation, write orders, and discharge instructions. It paid $8 for 3rd year students, and $15 for 4th years.

I made about $10K in beer money during my 4th year.

 

[BNZN32]

I actually work as an ED scribe doing the exact job you're talking about. We go see the patients w/ the doc, write the HPI, document the PE and ROS, and document every recheck, phone-call, consult, and procedure. It's awesome for the docs: they get out on time and have soooo much more time for actually practicing medicine. And its awesome for premeds who need healthcare experience. Here's the website for the company I work for:

www.emscribesystems.com

 

[AggieSean]

I actually work as an ED scribe doing the exact job you're talking about. We go see the patients w/ the doc, write the HPI, document the PE and ROS, and document every recheck, phone-call, consult, and procedure. It's awesome for the docs: they get out on time and have soooo much more time for actually practicing medicine. And its awesome for premeds who need healthcare experience. Here's the website for the company I work for:

www.emscribesystems.com

2nd this as a former scribe. We were also trained to determine when to "chart up" to a level 4 or 5, or when not to. We were regularly apprised of new methods to increase billing (smoking counseling, O2 sat interpretation, etc.). More $$$ and free time for the docs, great experience for us.

http://www.physicianscribes.com/history.html

 

[DrQuinn]

Is anyone else as exasperated as I am by the amount of documentation we do? At my program we are now being urged to write "sign-over" notes on patients signed out to us and on patients we are signing over to on-coming residents in addition to the note we've already written on the patient.

Signouts are some of the most dangerous parts of patient care. I have heard many different statistics but suffice it to say a large percentage of lawsuits hover around "signout" pateints. Timelines are unclear and who assumed care in what condition are usually the key to these cases. That, and, well, know they have TWO pockets to go after. The initial doctor and the receiving physician. So many residencies, and ED's, are now trying to tone down any chain of responsibilty and have you do signout notes.

I tell you I do them as an attending and unsure of exaclty how helpful they are but it is helpful when you read the chart...

"Signout from docB at 2130, pending CT scan of abdomen and pelvis. At 2230 CT came back negative, reeval patient, abd benign, no evidence of pathology on CT scna, pt to f/u with PCP, blah blah blah..."

It really helps close the loop in patient care.

One of the many loops we have ot go through. Let me tell you how much I love HAVING to fill out the ASA classification when I do conscious sedation. Its not like its hard but just kind of anoying.

Q

 

[Interpolfanclub]

Lately I've been doing re-eval notes on patients that get signed out to me, and when I have the time I print out an "ongoing care" form and write some things down but most of the time I just add on the existing sheet.

In patients that I sign out I'm consistently filling out a sign over note now. If it is a really busy day then I'm at work another hour but I feel better about leaving a clear plan for the oncoming resident. I'm going to try and make this a habit but we'll see.

 

[GeneralVeers]

I try not to sign out anything. If it's anything except a pending cat scan in 2 hours, then I'll usually wait and finish it.

 

[southerndoc]

I try not to sign out anything. If it's anything except a pending cat scan in 2 hours, then I'll usually wait and finish it.

Same here. When I do signout things, I clearly document it in the chart that care was turned over and to whom.