Tips for being more efficient?

[medstudent234]

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I'm wondering if anyone has tips for being more efficient on the wards? Seems like the other 3 interns on my service are consistently getting out 1-2 hrs before me right after they sign out, but I'm staying behind to finish H&Ps, DC summaries, etc. I think I do good to-do lists and I start my notes well before we even round, but I'm still slow. Any advice? TIA!!

 

[Doctor4Life1769]

Are you an intern? It's only been 2 weeks..

 

[medstudent234]

Yup, I'm an intern, I think it's a problem because I'm exhausted and am mostly doing busy work, not reading or learning with the extra time I'm at the hospital.

 

[Doctor4Life1769]

Yup, I'm an intern, I think it's a problem because I'm exhausted and am mostly doing busy work, not reading or learning with the extra time I'm at the hospital.

Welcome to residency

 

[Crayola227]

http://forums.studentdoctor.net/threads/things-to-do-to-shine-in-pgy-1.1188633/#post-17640862

my intern mega-post

enjoy

 

[Gastrapathy]

The first problem is the phrase "start my notes." You don't start a note, you write a note. If you have to go back and change it later, thats ok. Just put a note that you haven't rounded w/ attending yet and then erase that. No one reads intern notes. No one. Not even other interns. If they glance at them, its only at the A/P. Run a problem list, remove anything no longer relevant (I'm a fan of a list of "resolved problems: hyponatremia, urosepsis, AKI" at the bottom of notes. It lets folks know that you haven't forgotten but they are no longer active issues). Note writing cannot be a multistep process. The only note that matters is the discharge summary.

 

[Doctor4Life1769]

Now it's pure typing.

 

[Doctor4Life1769]

This is silly. You'll get faster with time. Focus on typing up good notes and be able to look like you have a clue on rounds

 

[FlowRate]

The first problem is the phrase "start my notes." You don't start a note, you write a note. If you have to go back and change it later, thats ok. Just put a note that you haven't rounded w/ attending yet and then erase that. No one reads intern notes. No one. Not even other interns. If they glance at them, its only at the A/P. Run a problem list, remove anything no longer relevant (I'm a fan of a list of "resolved problems: hyponatremia, urosepsis, AKI" at the bottom of notes. It lets folks know that you haven't forgotten but they are no longer active issues). Note writing cannot be a multistep process. The only note that matters is the discharge summary.

To add to this: Each day's note is a mix of today's to-do's and updates from the prior day/easy to add updates that you were able to glean from the five minutes you spent in the rest of the patient's chart before writing your note.

So to phrase it similarly again, you only start a note and finish a note. No editing, updating, etc. They are the same movement.

You do update your to-do lists and your signouts.

 

[galactus]

So to phrase it similarly again, you only start a note and finish a note. No editing, updating, etc. They are the same movement.

Truth. Also I love the "copy forward" button on the EMR. I started residency with paper charting notes and ended residency with 100% EMR. The time it took me to write notes were significantly cut down. As above, no need to edit (with the exception of updating conditions, like Day # of antibiotics, conditions improving/worsening/resolved, etc) . If you need to update, you can always add addendums/orders later.

 

[ThoracicGuy]

Truth. Also I love the "copy forward" button on the EMR. I started residency with paper charting notes and ended residency with 100% EMR. The time it took me to write notes were significantly cut down. As above, no need to edit (with the exception of updating conditions, like Day # of antibiotics, conditions improving/worsening/resolved, etc) . If you need to update, you can always add addendums/orders later.

I don't like "copy forward". It tends to just make lazy notes. I can't tell you how many notes I see from various people at my hospital that are copied from their previous notes. They don't edit it or minimally edit it. So something that might be relevant a week ago and has since resolved is still mentioned on the note at discharge.

 

[bashwell]

By the way @ThoracicGuy i love the new avatar, from the Expanse! Great science fiction show, with a huge dose of film noir. 🙂

 

[AdmiralChz]

I don't like "copy forward". It tends to just make lazy notes. I can't tell you how many notes I see from various people at my hospital that are copied from their previous notes. They don't edit it or minimally edit it. So something that might be relevant a week ago and has since resolved is still mentioned on the note at discharge.

This times one million. Copy forward can be helpful, but typically it's abused and never updated by lazy residents who never change anything except the bottom part of the plan. Countless patients I see who are noted to be intubated and sedated and yet I find walking around with PT in the hallways. Medicare and other insurers don't take too kindly to that sort of thing. Be smarter with your time, not laziness.

 

[FlowRate]

Truth. Also I love the "copy forward" button on the EMR. I started residency with paper charting notes and ended residency with 100% EMR. The time it took me to write notes were significantly cut down. As above, no need to edit (with the exception of updating conditions, like Day # of antibiotics, conditions improving/worsening/resolved, etc) . If you need to update, you can always add addendums/orders later.

What I meant by no updating is no updating later in the day after you've rounded with the attending, followed-up all the consults, and the labs finally return. If you try to keep the note up-to-date with all those things you're just wasting time, as they can all be added the next morning at once. I can't stand notes that don't update anything. I use a "resolved" problems section and try to keep the physical exam and problem list updated and prioritized.

 

[Doctor4Life1769]

Truth. Also I love the "copy forward" button on the EMR. I started residency with paper charting notes and ended residency with 100% EMR. The time it took me to write notes were significantly cut down. As above, no need to edit (with the exception of updating conditions, like Day # of antibiotics, conditions improving/worsening/resolved, etc) . If you need to update, you can always add addendums/orders later.

Not all EMRs allow this and most hospitals are not allowing this

 

[galactus]

This times one million. Copy forward can be helpful, but typically it's abused and never updated by lazy residents who never change anything except the bottom part of the plan. Countless patients I see who are noted to be intubated and sedated and yet I find walking around with PT in the hallways. Medicare and other insurers don't take too kindly to that sort of thing. Be smarter with your time, not laziness.

Lol yup. During residency it got so bad that the hospital actually removed the copy forward button on the EMR because of the abuse (mostly from residents). They put the function back a few months later. If done correctly and updating the note, copy forward is awesome.

 

[TooMuchResearch]

Not all EMRs allow this and most hospitals are not allowing this

Copy paste works well too.

 

[kchan99]

For D/C summaries, I wrote them at home most of the time.

Make sure to prepare D/C instructions on Friday for any weekend discharges, especially if you're not rounding on the day of the patient's discharge. This will help your co-residents who might not know the patient as well.

 

[Doctor4Life1769]

Copy paste works well too.

Nothing wrong with that but most interns are lazy as f-k

 

[MLT2MT2DO]

I don't like "copy forward". It tends to just make lazy notes. I can't tell you how many notes I see from various people at my hospital that are copied from their previous notes. They don't edit it or minimally edit it. So something that might be relevant a week ago and has since resolved is still mentioned on the note at discharge.

Then that's an issue with those residents, not the process. A copy forward note is still better than three words written out in chicken scratch with checkmarked boxes.

To be fair I probably change more words daily on just a cardiac ROS than most surgeons write in their whole subjective.

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[KnuxNole]

I don't like "copy forward". It tends to just make lazy notes. I can't tell you how many notes I see from various people at my hospital that are copied from their previous notes. They don't edit it or minimally edit it. So something that might be relevant a week ago and has since resolved is still mentioned on the note at discharge.

I liked that feature in the outpatient clinic, especially for follow up. I hated charts in residency. After my 2nd year, my clinic notes were heavily copy and paste, and it mad slightly easier to copy the H+P and the plan with some tweaks.

 

[ThoracicGuy]

I liked that feature in the outpatient clinic, especially for follow up. I hated charts in residency. After my 2nd year, my clinic notes were heavily copy and paste, and it mad slightly easier to copy the H+P and the plan with some tweaks.

Sure, if you take the time to read and edit your note, that saves time. Many people are lazy and don't. Or they only adjust one thing. Then those errors get swept through day after day.

 

[mvenus929]

Copy paste works well too.

Except that all of the refreshable smart phrases get deleted with copying and pasting.

 

[PTPoeny]

That depends on your EMR and how it is set up. Epic in residency was set up so that anything highlighted blue would update when you copied the note forward: vital signs, labs, i/o totals. My med school epic was not set up that way and it made copy and paste much less time saving.

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