How late do you stay after a shift?

[kat82]

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How late do you all stay after a shift to wrap up and finish charting? I have a hard time signing out stupid things so I often stay a bit longer, especially if I am writing charts, and then I'll sign out once I've finished my charts so that I have less to sign out. It usually ranges to between 30 minutes and sometimes up to 2 hours post shift

Some of our shifts have an hour of overlap which really helps but some dont.

 

[EctopicFetus]

Based on your title you must be an attending. I have seen these numbers really vary.

In my group I would say most people leave within 15 mins. I rarely leave after 15 mins post shift. At another place I interviewed it was 2-3 hours.. Sounded horrible to me.

 

[kat82]

Yep I am an attending. The built in hour of overlap really helps get me out on time since I don't have to see any new patients in the last hour- its really charting that keeps me staying late most of the time so I need to work on keeping up with it (I'm new). For shifts that don't have the built in hour of overlap, I get more screwed in terms of staying late since I'm seeing new patients up until almost the very end. Maybe I need to just pull back a little and learn how to say no

 

[dotcb]

As a 2nd year resident - 1-2 hours. By 4th year - 30 min. As an attending - 15 minutes. Chart in real-time as much as possible. Use every free moment to do charting, and don't pick up new patients with ~ 45 min left in the shift unless they're sick.

 

[EctopicFetus]

We have scribes.. they do a huge bit of our charting.

I would see what the culture of your place is. Most places I moonlit or worked people would stop seeing patients anywhere from 15-30 mins before the end of their shifts. I have seen patients left for over an hour. I think thats completely unacceptable.

Here is what I would do. FInd a doc in your group who is well respected and you respect. Ask them what they do or just wait til they sign out to you. Emulate that. It really is a culture thing.

 

[kat82]

Yeah I think since I'm new I'm afraid to let patients sit and wait around, but I literally will see a patient like 10 minutes before my shift is up, and then they're so fresh that I can't sign them out right away. I agree thats a bit much and probably worse for the patient. But when there is an hour of overlap, I think I'm expected to see new patients up until the new attending arrives since I"m paid for an extra hour to stay after they get there.

For fast track its tough- I can't stop seeing patients 30 minutes before the next attending gets there (no overlap in that shift) b/c the volume is so high and those patients are theoretically quick (though they never are, of course). We see upwards of 4-5 pts/hr in fast track right now which is semi manageable when I have enough help but I see plenty of primaries too, which makes it harder.

Again- its really the CHARTING that keeps me hanging around so I need to improve my charting in real time. Any tips on how to actually accomplish this?

 

[RustedFox]

Maaan. it IS the charting that's the monster. I'm a newly-minted attending, too... and I had a bear of a time in my first month trying to chart-chart-chart.

One strategy that helped me was to "tee up the discharge" when I was typing my H&P, if I felt pretty certain that the patient was going to go home. Write their instructions/followup/scripts then and there.

Apart from that, it really is "you need to chart in real-time". My drag was: I would "let" 3-4 "little" charts just sit for a bit, knowing that I would "get around to them"... and then I would get smacked with a patient who was turbo-sick and demanded time/bedside attention. THAT really put me behind.

Always work like "the bus" is coming.

 

[WilcoWorld]

Always work like "the bus" is coming.

That's great advice.

To the OP - It still varies significantly for me depending on the shift. This is partly because my shop's business is also quite variable. If at the end of my shift the waiting room is empty and every roomed patient has a clear dispo in place, I'll pretty much high five the next attending on my way out the door. If the waiting room has patients, and we've got a lot of incoming transfers, and it's the late shift (before we go down to single coverage) I may stay 2+ hours late.

Since you're relatively new to your shop, I would favor staying late at this stage, and scaling it back as you get to know the system and as you become established.

 

[8654Marine]

As posted earlier, get a feel for how the respected attendings hand off. (Hint: just because they've been there long, doesn't mean they know what they're doing)

This the art.

Just remember, some of the worst M&M's happen as a result of poor hand-offs.

Just don't be either of "that" attending:

(1) The one who always stays for 2 hours after
(2) The one who always leaves on time.

 

[jendc08]

I have been out for a year and work at a busy community place. Usually leave between 30-60 late but sometimes less. I try not to sign out anything unless it's something like a ct scan. I try not to pick anything up in the last hour unless they are super sick or quick unless I'm the overnight person because there is no overlap with the 6am shift. There used to be a guy in my group that would try to sign out central lines or iv placement for ct chest pe protocol. I wasn't that sad when he left...

 

[EM_Rebuilder]

Just don't be either of "that" attending:

(1) The one who always stays for 2 hours after
(2) The one who always leaves on time.

I really second this! Sometimes people get labeled a bit by always leaving on time or even early... occasionally is cool, but all the time creates resentment from others.

At the same time, don't be the goof that spends 2 hours every shift repairing things. It makes you look inefficient..

I have been out a year and we have scribes. I probably on average leave 15-20 mins past my time. Its rare that I leave early (like maybe 5 times in my year), and I do leave 'on time' on occasion depending on what 'shift' I am on. I have also had the occasional clusters where I stayed a good hour. We seldom sign things out and stop seeing patients an hour before our shift; we have multiple overlaping shifts so its not an issue.

 

[Daiphon]

Yeah I think since I'm new I'm afraid to let patients sit and wait around, but I literally will see a patient like 10 minutes before my shift is up, and then they're so fresh that I can't sign them out right away. I agree thats a bit much and probably worse for the patient. But when there is an hour of overlap, I think I'm expected to see new patients up until the new attending arrives since I"m paid for an extra hour to stay after they get there.

For fast track its tough- I can't stop seeing patients 30 minutes before the next attending gets there (no overlap in that shift) b/c the volume is so high and those patients are theoretically quick (though they never are, of course). We see upwards of 4-5 pts/hr in fast track right now which is semi manageable when I have enough help but I see plenty of primaries too, which makes it harder.

Again- its really the CHARTING that keeps me hanging around so I need to improve my charting in real time. Any tips on how to actually accomplish this?

Charting efficiency, I've found, depends heavily on your EMR system.

We use cerner/firstnet which not only pulls in a lot of info, but can also be macro'd & autotexted up the wazoo.

If your system lets you do something similar, then set up templates for level 1/3/5 charts... typically all I have to do is free text an hpi, tweak my basic ros/exam, and my MDM.

5-7min tops for a chart.

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[la gringa]

you can do some nifty stuff w/ firstnet... and most EMR's really

one of my least favorite aspects of my job is the lack of overlap and expectation things aren't signed out... very frustrating for me on the shifts where there is no triage doc.

 

[la gringa]

you can do some nifty stuff w/ firstnet... and most EMR's really

one of my least favorite aspects of my job is the lack of overlap and expectation things aren't signed out... very frustrating for me on the shifts where there is no triage doc.

 

[zinjanthropus]

15 minutes

 

[MiracleforMD]

Feel free to correct me if you feel otherwise about this issue. I work with many EM physicians and this issue has come up several times. A lot of them have explained to me that part of the ED lifestyle IS staying late when the waiting room is running Troponins. This is part of the package deal you get with only working 3 9's a week. Sometimes those 3 9's becomes 3 10's or even 3 11's, but it's not the end of the world.

 

[RustedFox]

Feel free to correct me if you feel otherwise about this issue. I work with many EM physicians and this issue has come up several times. A lot of them have explained to me that part of the ED lifestyle IS staying late when the waiting room is running Troponins. This is part of the package deal you get with only working 3 9's a week. Sometimes those 3 9's becomes 3 10's or even 3 11's, but it's not the end of the world.

The waiting room is running troponins? Did you mean to type that?

But yeah, sometimes I agree. Although its not considered "part of the job" by many, I have no qualms about staying an hour afterwards, because I only work 3-4 "eights" a week. Most people at my shop stay up to an hour afterwards to "clean things up" and avoid a sign-out.

 

[MiracleforMD]

The waiting room is running troponins? Did you mean to type that?

But yeah, sometimes I agree. Although its not considered "part of the job" by many, I have no qualms about staying an hour afterwards, because I only work 3-4 "eights" a week. Most people at my shop stay up to an hour afterwards to "clean things up" and avoid a sign-out.

Yeah, haha. I'm not sure what your place is like, but I have been told stories about EDs that are so backed up that labs/EKGs are being drawn/run in waiting rooms. People with a .14 Troponin obviously get brought back a little quicker. Never been that bad at the shop where I work.

Your take is similar to most of the docs where I work.