Problem-based inpatient notes in any Peds programs?

[pedsr3sident]

Hey guys,

Our hospital is considering transitioning from system-based assessment/plans for inpatient notes to problem-based notes on the floors like how Internal Medicine does it (ICU will stay system-based). Does anyone know any Peds program using problem-based notes? I've only ever experienced system-based notes on Peds, so I'm trying to get feedback on the experience, and any problems to anticipate. If there are any, I'd love to contact those programs to learn from their experience.

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[SurfingDoctor]

Hey guys,

Our hospital is considering transitioning from system-based assessment/plans for inpatient notes to problem-based notes on the floors like how Internal Medicine does it (ICU will stay system-based). Does anyone know any Peds program using problem-based notes? I've only ever experienced system-based notes on Peds, so I'm trying to get feedback on the experience, and any problems to anticipate. If there are any, I'd love to contact those programs to learn from their experience.

I've only seen floors used problem-based notes, but then again, if the hospital is accustomed to doing it system-based, why change?

 

[tantacles]

Hey guys,

Our hospital is considering transitioning from system-based assessment/plans for inpatient notes to problem-based notes on the floors like how Internal Medicine does it (ICU will stay system-based). Does anyone know any Peds program using problem-based notes? I've only ever experienced system-based notes on Peds, so I'm trying to get feedback on the experience, and any problems to anticipate. If there are any, I'd love to contact those programs to learn from their experience.

In my hospital, the attendings don't mess with the notes. The culture is systems based, but many residents (particularly med-peds residents) prefer problem based notes because most pediatric patients have only one problem so there isn't generally a need to go in depth on every system.

#Bronchiolitis
-Acetaminophen PRN
-Suction per bronchiolitis care path
-IV 0.9 NS @ maintenance
-Regular diet

Much easier than going through every system, no?

 

[MEN2C]

Hey guys,

Our hospital is considering transitioning from system-based assessment/plans for inpatient notes to problem-based notes on the floors like how Internal Medicine does it (ICU will stay system-based). Does anyone know any Peds program using problem-based notes? I've only ever experienced system-based notes on Peds, so I'm trying to get feedback on the experience, and any problems to anticipate. If there are any, I'd love to contact those programs to learn from their experience.

You're over thinking it. It's fine. It'll take 2 days to get used to and then it'll work out just fine. We did it differently based on which service we are on (Heme onc did systems based, floor did problem, ICUs did systems, etc). Don't worry about it.

 

[FrkyBgStok]

Early in residency we were systems based notes except NICU was always problem based. Half way through, our PICU transitioned to problem based and beginning of third year was a transition in the floor to problem based. It took a little bit of getting used to but, but once you got the hang of it, it was exponentially better. People liked it so much that by the end, every service in the hospital was doing problem based. It leads to better efficiency in the notes. Do you put the CBC in the heme section or the ID section? Or both? Do you put the coags in FEN/GI because we are looking at acute liver function? Do we put them in the FEN/GI section even though now we are monitoring DIC? Now, a kid comes in in DKA, you set that as the problem and all your plan goes in one section. Also easier for those reading the notes.

There was a lot of hesitation at first like I am sensing, but this is a good thing.

 

[DeadCactus]

In my hospital, the attendings don't mess with the notes. The culture is systems based, but many residents (particularly med-peds residents) prefer problem based notes because most pediatric patients have only one problem so there isn't generally a need to go in depth on every system.

#Bronchiolitis
-Acetaminophen PRN
-Suction per bronchiolitis care path
-IV 0.9 NS @ maintenance
-Regular diet

Much easier than going through every system, no?

But how will I provide good care without 10 paragraph note for a routine patient?!

 

[tantacles]

But how will I provide good care without 10 paragraph note for a routine patient?!

I don't like your tone, young man. All non-sick patients should be intensely scrutinized until you find something wrong with them or their family so you can keep them admitted for at least one week. If you can't find anything, it's important that you berate their indigent parents who work 80 hours per week for not being in the room at the very moment your team arrives to begin rounding.