There are days when it takes forever to finish rounds and go home. Even for an experienced hospitalist, it might take more than 12hrs some days.
Certainly, there are some techniques that anyone can use to finish rounding and actually finish the work for the day early on most days.
Start the day reviewing lab results and checking any events that happened over night for all of your patients. Start as many progress notes as possible. Finish seeing the patients. Enter orders as soon as you see each of your patients. Then, finish all your notes and sign them.
Make sure for each patient that a consult was placed by admitter where necessary. Early consults help in discharging early in some situations.
Document with bullet points in progress notes but explain in sentences where it is necessary.
Stop using unnecessary words in progress notes like “as well”. Some people have this habit of using ‘cliche’ words and they make progress notes very long wasting time for people who read their notes. Write ‘short and sweet progress notes’ covering all the points you wanted to include. When I was in residency, medicine dept chairman always used to say “Smart doctors write short and sweet patient notes”. Convey medical info in the most concise way possible. It should relay what you are thinking, satisfy billing requirements, and protect you from being sued.
Read the specialists’ notes and text them about the things which are not clear. If you need to talk to them about some important stuff, by all means, you should.
See the patients along with each patient’s nurse so that they won’t page you multiple times later. They can also explain the plan for the day to the patient and their families if they still have questions after your explaining to the patient/families.
Copying notes from the previous day has it’s own issues when editing is not done fully. Stop referring days as “today” or “yesterday”. Just put the ‘date’ of the events. Avoid writing “EGD is done today” instead write “EGD is done on 9/3/2020” so that when you copy forward the notes, there will be less stuff to edit.
Make sure you are in a position to reach anyone you need easily and immediately. For example, reaching tele monitor tech to know heart rhythm or rate, reaching nurses, reaching specialists, etc. I have cell numbers of almost all the specialists. Our EMR had updated phone numbers of all the nurses.
Update problem list in the morning so that diagnoses get updated while doing progress notes later in the day.
Try to do ‘batching of similar work’. Check labs for all patients at one time. See several patients at one time. Write orders for several patients at one time. Write progress notes for several patients at one time. Do multiple discharges at one time. Bill all patients at one time [probably most do this if using a special software like IMBills].
If you are busy on a particular day, eat lunch either early or little late. So that it will be quicker than usual time that you take on a regular day. I go to cafeteria at 1135am daily so that there are very few people so I don’t waste time standing in line.
Always, start the day early. I know a guy who earns almost double the rest of the hospitalists year after year. I wanted to study how he is able to do this. I noticed that he starts his day sharp at 7am. Checks all the lab results quickly and starts seeing all patients before other hospitalists. He finishes all his work by 2pm daily. After that he just answers nurses’ questions and takes care of any new developments. He never had any patient complaints.
Round on patients wherever they are. For example, they can be in HD unit, post in PACU, cath lab waiting for transport back to floor etc. If you wait for them to come back to floor, it will delay your work for that day.
Do not wait for results of all tests to be back to finish your progress notes. You can do addendum as and when new results come and plan changes.
Don’t talk too much with everyone you meet. Some people just want to talk a lot. Don’t get caught with them.
Sit in a quiet place while doing notes. There are certain quiet spots in every hospital. Go and quietly sit there and finish your work. This helps to make sure you are not missing anything on your patients.
Every day or whenever we need to do a lot of things, we make a “To Do list”. Sometimes, we have to make a “Not to Do list.” This list should have all the things you don’t want to do because they are wasting your time. Once written, its easy to follow. This list includes things like no too much socializing, not starting work late, etc.
Have dot phrases for important diagnoses like CHF, COPD, AFib etc. to hit all the core measures. Also have dot phrases to explain the risks involved when starting certain medications like narcotics, anticoagulants, amiodarone, statins, BZDs etc.
Learn you EMR thoroughly. Ask your colleagues periodically for any tricks that help them finish rounds quicker. In EPIC, you can change the settings to choose what columns you want in your patients’ list. I have the following columns in EPIC and pretty much they help me round efficiently daily.
Use speech to text software/dictation as much as possible. I see some people still type progress notes which delays finishing the work a lot.
Spend little bit more time on first day of your rotation with family so that the rest of the days, you can be quick with updates as they develop a good rapport with you from the get go.
If you have a way to know what patients you will see the first day of your rotation, it’s better to review your patients the night before your first day of your rotation which helps immensely with your entire week.
Happy fast and efficient rounding. Do the best you can and take good care of your patients which you already do.
