Anybody have tips on how to stay organized on a shift? I haven't found an efficient and organized way of keeping track of patients' notes, what's pending, dispo, who I charted on, etc..
Right now, i have a folded sheet of paper where i scribble notes on when in a patient room, then another sheet of paper where i jot down whats pending and check things off as they're done. This becomes very messy very quickly, and doesn't seem efficient to me.
What are your methods of staying organized?
I use the EMR. Here's the system I use 90% of the time.
Go see patient. Come back to desk. Write orders. Document history, physical, differential diagnosis, EKG interpretation, and interventions. Check the critical care box if applicable.
Repeat x 2-4 depending on how busy it is and how slow lab/x-ray are.
Go back to computer and look at x-rays and labs of patient #1. Order additional tests if necessary (rare). Disposition patient. No one leaves the department until my chart is done. But at this point, all I need to do is put in the labs and x-rays, diagnosis, scripts, and discharge instructions.
Pick up another patient.
Disposition a patient.
Pick up a patient.
Disposition a patient.
Then in my last hour, I disposition 3-5 patients.
I write nothing down except perhaps the PCP's name or perhaps a few key words to help me remember a complicated HPI.
The other 10% of the time occurs when the department gets either very busy and I don't have 2 minutes to do the initial documentation stuff. But I still don't let people leave without their chart being done. I make too many mistakes (overlooking labs, forget a script etc) if I don't do that.
I mean, think about it. There is a certain amount of work you must do during a shift. You must interview a certain number of patients, examine a certain number of patients, go back and reexamine and talk to a certain number of patients, interpret all their labs and x-rays and do the charts. You can do this stuff in any order you want. Why not do it in the most efficient manner for you whenever possible? Occasionally, EM being what it is, you get knocked out of your rhythm. But the more you can stay in your rhythm, the happier you are and the better care you deliver.
I rarely carry more than 7 patients at a time. By the time I've picked up seven SOMEONE is ready to be dispositioned. Lab and x-ray aren't that slow. If you prioritize your discharges/admissions, then you keep the department emptier. This makes it easier for you to remember all your patients and keep track of what's going on with them, but more importantly, it frees up your nurses, techs, and clerks to do what you want them to rather than deliverying diet cokes and warm blankets and talking to family over and over again while they're waiting for you to come back and talk to them about their studies. Free the nurses free yourself.
Also, you do get better at this as the years go on. You learn to see the end from the beginning. You also learn to order all your studies at once, and interpret them all at once. If you have to stop and interpret each individual study as it comes back, that's inefficient. Just wait til they're all back, then disposition the patient. Also, it helps if you get your consultants to use cell phones instead of pagers. Yes, sometimes a message has to be left, but you spend a lot less time waiting to talk to them.
