Does your hospital require dictating every ED visit?

[SolidGold]

Just curious because we do it here, but dictations were not something done at other hospitals I rotated at as a student. I don't have much experience with ED dictations yet so i'm neutral right now, but anybody have any opinions for or against dictating in the ED?

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[deleted109597]

If you ask the kids from Wake Forest, there is a slight ambiguity towards it. It is extremely fast (remember, you need to say "insert my standard ali raja complete this dictation template"), but you end up not writing anything down, so until it is typed out, nobody can see anything.
On the flip side, the WF people used to dictate, then went to a computer system. You don't remember the patients as well because you aren't going through the same mental pathways, according to them. It also takes longer to find the correct things and click them.
However, your hand doesn't get as tired from either of them as it does somewhere where you have t-sheets (Jax et al.)

 

[deleted6669]

I work at a few places:
1.at a busy trauma center we use something very similar to T-system.
2.at a community e.d. we use an EMR that can be accessed for charting by typing or dictating( I dictate at this place).
3.at a rural e.d. we dictate 100% of the charts( but that's only 12-16/shift).
4.at another small e.d. we write directly on a 2 pg chart that is similar to what most places used 10-15 yrs ago(very fast, I really like this system.....)
5. at a free clinic I write soap notes on a blank page that the nurses have written vitals/meds on.

dictating is great if you remember to dictate everything you actually asked and everything that happened. the advantage of T-system and other similar charts is that they prompt you to remember to chart everything that you did by having a space for everything. when you first start dictating make yourself a little cheat sheet that you carry in your pocket and then just work your way down the sheet for every dictation until you have the system memorized. that way you won't forget to mention a lab, diagnostic study, or consult.

 

[Dr. Will]

Just curious because we do it here, but dictations were not something done at other hospitals I rotated at as a student. I don't have much experience with ED dictations yet so i'm neutral right now, but anybody have any opinions for or against dictating in the ED?

Dude...they were a nightmare. It can only get better, I hope. It really is about what you document in your H and P. The better you get at documenting, the easier dictating will become.

 

[southerndoc]

We never dictate. Everything is Lynx template based charting.

 

[TysonCook]

We do not dictate as residents at Carolinas, but our attendings may choose to dictatate their note if they feel that it is necessary. No dicatation is good for us, but the charting can be time consuming

 

[Jeff698]

We use SmartNotes, a templated paper system similar to T sheets. We used to dictate. I've now used both for about a year each.

I prefer dictation. For me, it's faster and certainly much more informative to anyone who takes care of that patient again in the future.

After getting extensive feedback from our coders, I'm able to dictate notes that allow very good billing. I think I can do it as fast or faster than with SmartNotes (probably in part because of how we've implemented them here).

Some of my colleagues really like the SmartNotes and feel like they're faster with them. To each their own, I guess.

Take care,
Jeff

 

[SolidGold]

Dude...they were a nightmare. It can only get better, I hope. It really is about what you document in your H and P. The better you get at documenting, the easier dictating will become.

Damn...well, it only can get better, it's just a matter of how fast. I guess I'll be writing a lot on the head sheet at first. It sounds like dictating is something that works to our advantage in the end, once we get good at it.

Using a T-sheet (or something similar) was quick in my opinion, but I can see how difficult it can be when you want to have details about prior ED visits because some attending EP's don't document much at all from what I've seen.

How does something like SmartNotes work? Check boxes on the computer screen kind of thing?

 

[Jeff698]

How does something like SmartNotes work? Check boxes on the computer screen kind of thing?

SmartNotes is a paper template system, similar to T sheets. I use T sheets where I moonlight and prefer SmartNotes (although I'd rather dictate than use either).

There is a consistent layout from complaint to complaint (all of these products are complaint based) with SmartNotes and more room to write than with T sheets.

T sheets also has a computerized version. Here's their web site: http://www.tsystem.com/default.asp.

Here's the SmartNotes web site: http://www.edsmartnotes.com/index.htm. Much less revealing.

Take care,
Jeff

 

[BADMD]

Just curious because we do it here, but dictations were not something done at other hospitals I rotated at as a student. I don't have much experience with ED dictations yet so i'm neutral right now, but anybody have any opinions for or against dictating in the ED?

Where I just finished, everything was paper T plus a short dictation focusing on medical decision making and hospital course. The coders felt they could not get enough of the MDM out of the T to reliable bill level 4's and 5's. Plus, the floor complained people complained they could figure out what was occurred in the ED from just the T.

Where I'm going, everything is dictation based with some templates. Frankly, I'm so used to dictating at this point, that adding a little more HPI, ROS, and social Hx isn't much of an addition.

 

[roja]

I have never ever dictated. I will break out in hives when I do. I process better when I am writing. or typing. and I type fast.

 

[EctopicFetus]

We dictate all but the urgent care charts. It can be nice and quick or depending on the patient (like the border crosser I had who died from exposure) can take a long long while. Most dictations are 5-6 mins with a few in the 4 minute range and a few outside of it. It really isnt terrible once you get used to it.

 

[DrMom]

Our attendings dictate every patient. We do paper charts (similar to T-sheets, but home-grown format) that they use to dictate from. We're supposed to be doing some practice dictations so that we can get into the pattern of it.

 

[Midwest Medic]

My program used to do dictations for our first year, then moved to the AAEM form of templates for cost reasons. Where I am moonlighting we dictate. I personally like dictations MUCH better. It seems to take a little bit longer (2-3 minutes extra per patient to get a good dictation in), but I can get more of my decision making and thoughts on the record better. Also, according to our malpractice carrier, the template systems are a little harder to defend unless you really put a lot of extra writing on it. Also, I don't really care for the amount of space to put any abnormal physical findings on out templates. It seems like you have to write very small to fit anything in.

 

[SolidGold]

So after seeing and signing about 30 dictations the other day, I've realized that they didn't come out nearly as bad as I thought they would. In fact, I was impressed by some of them. I've also managed to do most of mine in less than 5 minutes already, so I'm becoming a fan of dictating in the ED but I still can become more efficient at it especially hearing how the seniors dictate.

 

[Seaglass]

If you ask the kids from Wake Forest, there is a slight ambiguity towards it. It is extremely fast (remember, you need to say "insert my standard ali raja complete this dictation template"), but you end up not writing anything down, so until it is typed out, nobody can see anything.
On the flip side, the WF people used to dictate, then went to a computer system. You don't remember the patients as well because you aren't going through the same mental pathways, according to them. It also takes longer to find the correct things and click them.
However, your hand doesn't get as tired from either of them as it does somewhere where you have t-sheets (Jax et al.)

Actually, being one of those WF people who did both - dictation was nice and I prefer it to paper, but computer T eventually became pretty good (even great maybe) and I would actually prefer that now.