SOAPs

[vetsahoyVMCVM]

As a student, I'm surrounded by advice on how to survive clinical year and how to be an efficient clinician post-grad. One thing that I saw was going in early and completing your SOAPs for the day if you have patients from an overnight shift. Here's my question, how are you supposed to complete the SOAPs for the day in the morning? Or am I completely misunderstanding that? I guess I could see completing the subjective in the morning since what the owner complained about shouldn't change overall, right? Hope this makes sense!

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[Minnerbelle]

As a student, I'm surrounded by advice on how to survive clinical year and how to be an efficient clinician post-grad. One thing that I saw was going in early and completing your SOAPs for the day if you have patients from an overnight shift. Here's my question, how are you supposed to complete the SOAPs for the day in the morning? Or am I completely misunderstanding that? I guess I could see completing the subjective in the morning since what the owner complained about shouldn't change overall, right? Hope this makes sense!

SOAPs usually get done first thing in the day, so I’m not sure how going in early is going to help other than that it gives you a little more time? Each service does their soaps a little differently, but the gist is:

The subjective is your history - a brief (and I mean brief) recap of why the patient presented, and what storyline changed between being admitted or last SOAP and this morning.

objective is your PE

assessment is your current assessment with relevant historical assessment with updated ddx list. The first being why they’re currently admitted, and then other comorbidities, with a blurb about how things are progressing (improved overnight vs. resolved vs. stable, etc...)

plan is what you plan to do for the day. You add on to it as you complete these things so that by the end of the day it’s done. The plan is your tentative plan, and you alter it as the day goes on

 

[CalliopeDVM]

Here's my question, how are you supposed to complete the SOAPs for the day in the morning? Or am I completely misunderstanding that? I guess I could see completing the subjective in the morning since what the owner complained about shouldn't change overall, right? Hope this makes sense!

You complete it with up to date (at that time) information for the S, O, and A sections; your Plans are what you plan to do that day based on your current information and the patient's current status. Of course you won't know what will result from those plans, but that's OK at this stage.......updates are added throughout the day (sometimes just the A and P sections, sometimes all the sections).

 

[itsrocky]

For most of the rotations at my school, we would need our soaps done by 8 am and the house officers would look over them to make sure we had the format down. The A and the P in particular when done in the morning are good spots where you can show your knowledge on the case—that you know all of your differentials, and that you independently formulated a treatment plan that could (and probably will) change once rounds is done. As clinics progress it trains you to come in for treatments, assess your patient, and give your clinicians the plan that you came up with. It’s a way to assess knowledge base and clinical reasoning.

I always wrote mine out as completely as possible the night before, changed it to reflect the patient’s current status, and pasted into the medical record. Saved me a lot of extra time in the morning

 

[JaynaAli]

I think minnerbelle’s explanation is great. As an intern we had to have SOAPs done by 8 am rounds, ideally closer to 7 because an emergency could come in as the overnight doctor was wrapping up and an intern was expected to take those. We usually did an afternoon update every day where we would put a short blurb about how the patient did over the day and listing the relevant results from your diagnostic tests you did that day or how the patient was responding to the therapy. As a student we had more time to complete them but it will be easier to do them early before you’re busy with a zillion other things than trying to fit it in In the afternoon.

For inpatients the S part of the document is good for notations about food and water intake, urination and defecation and general demeanor since the night before/your previous SOAP entry. After the first day there’s little need to recap the history beyond a single sentence in the S section unless the owners report new information that day.