I was recently hired as an ER scribe. I am almost done with my training, but I am having some trouble with speed. Sometimes I can't keep up with all the charts. I think it's mostly because it takes me a while to finish my HPIs. So I was wondering if you guys could give me some advise/tips on how you guys managed to keep up with charts when you guys were starting off. Also, any other tips on how to become a successful scribe are welcomed
Scribe Advise/Tips
- Thread starter Nsn7
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Well, unless you guys are like on the brink of going on bypass, just gently remind the doctor that you are new. The ultimate responsibility for your charting falls upon them, so they'll want to make sure it's good.
Also, it just comes with time. You'll figure out your own way to weather the storm. It took some time, but I got to the point of having HPI and ROS done before we left the room (nurses entered history/meds). Before that, I would just free-text my note, and then once I had some time (like doc goes to enter orders) that's when I would check all my boxes and dot my i's. I also got pretty good at internalizing the history, so by the end if I did get behind I could pretty easily finish things out.
So breathe, you'll be fine. You just need repetition and time. Once you calm down and get a handle on things it's the best job ever.
Also, it just comes with time. You'll figure out your own way to weather the storm. It took some time, but I got to the point of having HPI and ROS done before we left the room (nurses entered history/meds). Before that, I would just free-text my note, and then once I had some time (like doc goes to enter orders) that's when I would check all my boxes and dot my i's. I also got pretty good at internalizing the history, so by the end if I did get behind I could pretty easily finish things out.
So breathe, you'll be fine. You just need repetition and time. Once you calm down and get a handle on things it's the best job ever.
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First off, the speed will come. Especially on your first day "on your own," you will probably feel overwhelmed. That's ok. It will pass. It might take a few months, but eventually it will all become second nature.
As far as some general tips:
-Try and finish the HPI, ROS, and PEx before leaving the room. This won't always happen, and will take some time. If you can finish the MDM, bonus points. But if you get at least the first three done, it's easy to come back and finish the MDM.
-For the HPI, remember to only include pertinent parts of the patient's story. Patients, unfortunately, don't dictate notes well. Their stories can wander here and there, and you probably don't really care about certain things. Tell a story here; this is your chance to paint picture of what's going on. Make sure it's complete, but some things just aren't relevant.
-For the PEx, the doctors you work with will probably either 1) note findings aloud in the room or 2) tell you when you leave. Particularly for the first option, don't always write things down exactly as they say them. For example, they might tell the patient, "You've got a pretty good scrape on the back of your head." Don't write that down. Write down "1x2 cm [get the size outside the room if they don't say it] abrasion to occiput. No active bleeding noted. No crepitus or deformity [etc..]."
-For the MDM, this is where you list your differential diagnoses, why you (well, the doctor, but you're writing it, depending on where you work) feel that XYZ test would or would not benefit the patient, etc. Defend the course of care with the court and other doctors in mind. Document important discussions with the patient (refusals of care, imaging risks, etc.).
-If it's going to be a quick discharge (e.g. you are working in fast track), try and get the discharge instructions completed before leaving the room before working on the MDM, so the doctor can just take over the chart and print them out quickly if they are moving fast.
Above all, don't be afraid to ask questions. Obviously, make sure your timing is good (don't ask right as he/she is about to do something or is thinking through an issue). But generally they are happy to explain things or give you more information. Good luck!
As far as some general tips:
-Try and finish the HPI, ROS, and PEx before leaving the room. This won't always happen, and will take some time. If you can finish the MDM, bonus points. But if you get at least the first three done, it's easy to come back and finish the MDM.
-For the HPI, remember to only include pertinent parts of the patient's story. Patients, unfortunately, don't dictate notes well. Their stories can wander here and there, and you probably don't really care about certain things. Tell a story here; this is your chance to paint picture of what's going on. Make sure it's complete, but some things just aren't relevant.
-For the PEx, the doctors you work with will probably either 1) note findings aloud in the room or 2) tell you when you leave. Particularly for the first option, don't always write things down exactly as they say them. For example, they might tell the patient, "You've got a pretty good scrape on the back of your head." Don't write that down. Write down "1x2 cm [get the size outside the room if they don't say it] abrasion to occiput. No active bleeding noted. No crepitus or deformity [etc..]."
-For the MDM, this is where you list your differential diagnoses, why you (well, the doctor, but you're writing it, depending on where you work) feel that XYZ test would or would not benefit the patient, etc. Defend the course of care with the court and other doctors in mind. Document important discussions with the patient (refusals of care, imaging risks, etc.).
-If it's going to be a quick discharge (e.g. you are working in fast track), try and get the discharge instructions completed before leaving the room before working on the MDM, so the doctor can just take over the chart and print them out quickly if they are moving fast.
Above all, don't be afraid to ask questions. Obviously, make sure your timing is good (don't ask right as he/she is about to do something or is thinking through an issue). But generally they are happy to explain things or give you more information. Good luck!
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Keep good paper notes on patient names, MRNs, and/or room numbers in order to keep track of everyone. This will help ensure that you don't miss a chart somehow because they got discharged while you were swamped with other charts.
Are you having trouble keeping up with the patient's story or the dictated physical exam findings while in the room? Checking all of the labs and keeping the chart up to date? Writing the MDM once out of the patient room? Those are all separate issues, and identifying which is your main problem will help you target a solution better. Practice typing faster at home, because that always helps. I also had my boyfriend read some random paragraph in a book aloud or list some random items while I typed it all down; this helped me get better at remembering what was said if I couldn't type it fast enough.
That was definitely my biggest problem -- if the doctor said, "1.5 cm laceration on the medial aspect of the left lower extremity. No fluctuance or surrounding erythema. Several ecchymoses superior to the laceration. No palpable masses or deformities. Good range of motion. Capillary refill brisk and intact.", I would get the first two sentences and the last two, but just miss the stuff in the middle because I couldn't listen to one thing and type another, and I couldn't remember things after they were said. So I practiced this skill at home, and it got better. I don't have an issue with this at all anymore. I'm sure this difficulty would have naturally gone away, but I feel like practicing extra expedited the process.
Another thing that comes with time is the ability to keep track of 10+ people at a time. During my first few shifts, I had a super hard time mentally shifting between patients. I couldn't remember who was who, what complaints they had, what rooms they were in, or anything about their stories. After a few weeks, this just vanished. I've heard similar things from other people. Being able to remember who all of your patients are will help you keep track of charts better, because you'll think, "Hey, what happened to that 80 year old with CHF who fell this morning?" and you'll check up on the chart. It's much much harder when you don't have that intuition yet, and that CHF lady is just not at all on your radar. But it comes with time!!
Good luck 👍
Are you having trouble keeping up with the patient's story or the dictated physical exam findings while in the room? Checking all of the labs and keeping the chart up to date? Writing the MDM once out of the patient room? Those are all separate issues, and identifying which is your main problem will help you target a solution better. Practice typing faster at home, because that always helps. I also had my boyfriend read some random paragraph in a book aloud or list some random items while I typed it all down; this helped me get better at remembering what was said if I couldn't type it fast enough.
That was definitely my biggest problem -- if the doctor said, "1.5 cm laceration on the medial aspect of the left lower extremity. No fluctuance or surrounding erythema. Several ecchymoses superior to the laceration. No palpable masses or deformities. Good range of motion. Capillary refill brisk and intact.", I would get the first two sentences and the last two, but just miss the stuff in the middle because I couldn't listen to one thing and type another, and I couldn't remember things after they were said. So I practiced this skill at home, and it got better. I don't have an issue with this at all anymore. I'm sure this difficulty would have naturally gone away, but I feel like practicing extra expedited the process.
Another thing that comes with time is the ability to keep track of 10+ people at a time. During my first few shifts, I had a super hard time mentally shifting between patients. I couldn't remember who was who, what complaints they had, what rooms they were in, or anything about their stories. After a few weeks, this just vanished. I've heard similar things from other people. Being able to remember who all of your patients are will help you keep track of charts better, because you'll think, "Hey, what happened to that 80 year old with CHF who fell this morning?" and you'll check up on the chart. It's much much harder when you don't have that intuition yet, and that CHF lady is just not at all on your radar. But it comes with time!!
Good luck 👍
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