Is the Psych call so busy everywhere?

[Psychintern2006]

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I started this July. I am quite worked out already, doing 6 calls every month and stay up most of the night, averaging 4-5 admissions one every call, the pt interview takes hardly 45 minutes to one hour, but the thing that kills me is the scutwork where we have to enter all pt exam on the computer system including HPE, MSE. It is taking 3 hours on average per patient, so 4-5 admissions plus inpatient calls make it a horrible call. The Dept. is not interested in getting Dictations or Paper notes for admisssions. Feels life style is infact not that great. I just hate calls😱 Even medicine and surgery residents are getting to rest for atleast 2-3 hours 🙁 .

 

[Anasazi23]

It shouldn't be taking you an hour to interview patients. 20-30 mins max. One hour intakes are for complicated patients or private practice patients who are willing to pay for it. Also, it's ok to interview someone for an hour if you're the resident taking the patient the next day.

When you're on call, you're doing damage control. Routine stuff waits for the next day, and you're "holding down the fort." I tell this to my interns also. If you know that you're averaging that many admissions, you need to cut the fat. Get the basics, stabilize the patient, delegate duties to nurses and other staff, put in the orders, and move on. Talk to someone who does faster admits than you. See where they're trimming, and how they get through the computer so fast. Usually a computer system is faster. Perhaps this, besides the hour interview, is where you're getting bogged down.

Yes, lifestyle sucks as a resident. It's better in psychiatry (or should be) but will be much, much better later on.

1/2 hour interview + 15mins admission scut = 45 minute admission.

 

[TheWowEffect]

I started this July. I am quite worked out already, doing 6 calls every month and stay up most of the night, averaging 4-5 admissions one every call, the pt interview takes hardly 45 minutes to one hour, but the thing that kills me is the scutwork where we have to enter all pt exam on the computer system including HPE, MSE. It is taking 3 hours on average per patient, so 4-5 admissions plus inpatient calls make it a horrible call. The Dept. is not interested in getting Dictations or Paper notes for admisssions. Feels life style is infact not that great. I just hate calls Even medicine and surgery residents are getting to rest for atleast 2-3 hours .

Things will get better as you get more experienced. Try to stick the minimum required basics as the other post mentioned and don't spend more than 30-40minutes for the interview. For some floridly pschotic/manic patients, it shouldn't take you more than 15-20 minutes. I don't know how computer system at your hospital works but you can try making templates for HPE and MSE and modify it for each patient.

1/2 hour interview + 15mins admission scut = 45 minute admission.

45 minutes would be too much expect from someone who takes 3 hours to do it. I think 60 to 75 minutes will be more reasonable as an immediate target.


P.S.- Remember that you are admitting the patient. Leave the psychoanalytic/CBT/interpersonal part for later if you are running short on time.

 

[MBK2003]

I gotta agree here, 20-30 min to interview the patient and then 45-60 min to do the written admit note and the admission orders. Something I notice from our current batch of interns are LONG admission notes with quite detailed past psych histories, developmental histories, and psychosocial summaries that will put the inpatient social worker to shame. Frankly, while it's all good patient care and makes life MUCH easier for the inpatient team, it's ultimately unnecessary because it's an overnight admission and you are the one who's getting killed. Accept that you won't always have the most inclusive/comprehensive admissions notes and move on toward the call room. We all like to bask in the glow of the praise from the inpatient attendings about our stellar admit notes, but ultimately we need to be selfish and cut corners where available to get some sleep.

MBK2003

 

[Psychintern2006]

Good to hear from you guys. I am interviewing in 30 minutes tops, but it is hard to type HPI and MSE so fast. What is the average number of admissions you are getting over one night?

 

[Anasazi23]

I can get 5-7 on a bad night. We have no dedicated psych ER, so I have to see the patients from the beginning, which makes it longer.

Have pre-typed normal physicals and MSE's on hand. Then copy and paste, putting pertinent positives where previous normal results were.

 

[Anasazi23]

Or take a typing class. Hands down the smartest thing I did in high school.
(my plan to meet girls AND get a lifelong skill both worked 😉 )

There are free online typing tutors that dramatically increase your typing speed. It's an almost necessary skill nowadays. Try to hit at least 45-50 wpm. It'll help you a lot.

 

[OldPsychDoc]

...
Have pre-typed normal physicals and MSE's on hand. Then copy and paste, putting pertinent positives where previous normal results were.

Be careful. I almost feel like I need to teach a course on proper use of electronic medical records to students and residents. Yeah, copy & paste can save a bunch of time, but it is a GREAT way to carry forward "chart weeds" and errors. I'm getting sick of HPIs which are unedited cut-outs of an ER social worker's note. Also in the past month I've had "normal" physical exams placed in H&P's of pts with gross LE phlebits and pitting edema, and a goiter visible from across the room. The latter specifically contained the phrase "thyroid not enlarged"!!!!😱 Maybe you're working for an attending who you WANT to see sweating on the witness stand after he signs off on your error...but please don't commit fraud in the medical record!

 

[Anasazi23]

Of course, OPD. But I must also say, that I've seen an equal amount of rote normal written PEs. If you actually examine the patient, you'll remember the positives..murmer, goiter, cellulitis, vascular insufficiency, edema, crackles, rales, etc....at least I hope.
😳

 

[Psychintern2006]

Typing class looks like a good idea. Though I type at an alright speed, I also noted that errors come across especially if the pt has been a frequent flier. Somehow the pt denied PE and I entered pt denied on front sheet, but the computer copied it from last time! 😱
Thanks

 

[ORBITAL BEBOP]

how many of you have to take care of the paperwork concerning transfers, state transfers, preauthorization even for an inpt stay, etc? We have to do this and it sucks!

 

[Anasazi23]

how many of you have to take care of the paperwork concerning transfers, state transfers, preauthorization even for an inpt stay, etc? We have to do this and it sucks!

Transfers, yes. Since it is clinical medical information that is intended for "doc-to-doc" purposes.

Preauthorization? Bullpoop. That is either attending (if it's private) or social work's job. Complain to your program director.