Welcome to the hospitalist fam. I'm a bit of an efficiency junky, so I'm interested to hear how you'll streamline your workflow and documentation as you go! I pre-chart from 7(:30) to 8/9 before seeing all patients by 11-12. While pre-charting, I spend more time than I'd like manually writing down pertinent history and notes-to-self on paper to serve as reminders for when I'm rounding, which is a step I'd like to figure out how to skip by just documenting into the EMR directly, but paper is still the most organized and concise way to jot down these notes for now. I recently also pared down my notes significantly by removing extraneous information including auto-populated labs and imaging results, since they don't actually add anything of value to your documentation unless interpreted, and now I just use a list of diagnoses and single list of items in the plan rather than separating the A&P by problem, which actually ends up being more organized and to the point (i.e., rather than writing c/w metoprolol 3 separate times under AF, HF, and HTN). I do want to dictate more while rounding though to get the notes signed by the time I'm finished (or else I find myself writing notes all afternoon trying to remember which of my 15 patients mentioned the minor inconsequential headache, etc.)
I absolutely love this response - and thank you so much for taking the time to write it! Your pre-charting timeline actually seems pretty similar to me right now, precharting from 7:30-9:30ish (sometimes I went even past 10 though lol) and then seeing all the patients by 11-12. In terms of what you talked about with writing down notes directly in the EMR, that is actually something I do as well! I find it helpful because while I am walking to the next patient I can pull up the note I pended right on my phone if I needed to remind myself of something. My patient list still is where I put all of my to dos and where I track down what each patient said to me / anything pertinent on their physical exam for that day. I have seen people do the single list of items thing and honestly I agree with you that sometimes it can be so much more concise and clearer than individual A/Ps for each problem. Sometimes when there is too much text it becomes really easy for other people to stop even reading the note altogether I feel like. But if there is just one main area that they need to look at, they might actually take the time to read through the whole thing. It probably saves you so much time doing that as well. It would take a lot of getting used to, since I've never done that style before so it feels like it'd be a little bit of an adjustment to try to get used to it. Regarding dictating - definitely seems like it would save time because even though I type quickly, I feel like this week was the first time I was like dang my fingers are literally super tired at the end of the day. I just downloaded the dictation software for my institution so might try it out as well haha, but again it's an adjustment when we are so used to typing everything out! Can't wait to hear more from you if you find more tips & tricks for your workflow! And thanks again for the awesome comment :D
New attending here as well. Just completed week two. I have found that spending 1-2 hours the day before pre-charting on all the pts really helps on day one because I can just focus on prepping note with 24 hour events and adding A/P info. I tried going in blind the first day with no pre charting the day before and it took forever. Lol
i do pre rounds, chart rounds early in the morning then see all my 13-14 patients in one go. by 11-12pm, i do all my notes, consults and be done by 2-3 and go home
Wow used to be 15 back in my day at UCD. 13 sounds so chill. Usually seeing 12-18 plus admitting depending on the hospital. Lately been dialing back and signing up for "helper" shifts, can pick up a short list of 10-12 pts and get out in 4-5h and have almost a whole day free. Every patient after 12 seems to add exponentially more work/time
Yeah! They dropped the cap to 13 about a year and a half ago I believe. I can't imagine what it would have been like with 15 patients!😬 Those helper shifts sound pretty legit! Sometimes when I do finish early I still stick around until 4ish just in case something happens - but maybe I'll start feeling more comfortable over the next few weeks :) I also still write way too much haha so need to cut down on that. Did you ever get into dictating btw? Wondering if it's worth trying that out
Our cap at our academic hospital is actually 13 which is pretty low and quite nice. It used to be 15. I think the average cap nationally is around 15-18
Hi Doctor. Please help. I know you cant give specific details. My question... Im an obese guy. At night my heart rate goes to low 50s. Made it through ARDS covid.... My ekg says RBBB and possible miocardio infarct with indeterminate age and my Doppler says diastolic heart failure. Any of these related to nocturnal bradycardia? Thank you!! 👍
Right bundle branch block with a possible prior myocardial infarction in that region could suggest you had a small heart attack on the right side of your heart sometime in the past, which supplies the SA and AV nodes that control your heart rate. You definitely should get a stress test to see if you have any coronary artery disease (blockages in the blood vessels to your heart). The best way to treat your diastolic heart failure is with weight loss and managing high blood pressure which is the most common cause. Hope that helps!
excited to see a tour of the new note template
What are your tips for your prerounding workflow? Let me know what have been the most helpful practices and revelations you've discovered :D
Welcome to the hospitalist fam. I'm a bit of an efficiency junky, so I'm interested to hear how you'll streamline your workflow and documentation as you go!
I pre-chart from 7(:30) to 8/9 before seeing all patients by 11-12. While pre-charting, I spend more time than I'd like manually writing down pertinent history and notes-to-self on paper to serve as reminders for when I'm rounding, which is a step I'd like to figure out how to skip by just documenting into the EMR directly, but paper is still the most organized and concise way to jot down these notes for now. I recently also pared down my notes significantly by removing extraneous information including auto-populated labs and imaging results, since they don't actually add anything of value to your documentation unless interpreted, and now I just use a list of diagnoses and single list of items in the plan rather than separating the A&P by problem, which actually ends up being more organized and to the point (i.e., rather than writing c/w metoprolol 3 separate times under AF, HF, and HTN). I do want to dictate more while rounding though to get the notes signed by the time I'm finished (or else I find myself writing notes all afternoon trying to remember which of my 15 patients mentioned the minor inconsequential headache, etc.)
I absolutely love this response - and thank you so much for taking the time to write it! Your pre-charting timeline actually seems pretty similar to me right now, precharting from 7:30-9:30ish (sometimes I went even past 10 though lol) and then seeing all the patients by 11-12. In terms of what you talked about with writing down notes directly in the EMR, that is actually something I do as well! I find it helpful because while I am walking to the next patient I can pull up the note I pended right on my phone if I needed to remind myself of something. My patient list still is where I put all of my to dos and where I track down what each patient said to me / anything pertinent on their physical exam for that day.
I have seen people do the single list of items thing and honestly I agree with you that sometimes it can be so much more concise and clearer than individual A/Ps for each problem. Sometimes when there is too much text it becomes really easy for other people to stop even reading the note altogether I feel like. But if there is just one main area that they need to look at, they might actually take the time to read through the whole thing. It probably saves you so much time doing that as well. It would take a lot of getting used to, since I've never done that style before so it feels like it'd be a little bit of an adjustment to try to get used to it. Regarding dictating - definitely seems like it would save time because even though I type quickly, I feel like this week was the first time I was like dang my fingers are literally super tired at the end of the day. I just downloaded the dictation software for my institution so might try it out as well haha, but again it's an adjustment when we are so used to typing everything out!
Can't wait to hear more from you if you find more tips & tricks for your workflow! And thanks again for the awesome comment :D
New attending here as well. Just completed week two. I have found that spending 1-2 hours the day before pre-charting on all the pts really helps on day one because I can just focus on prepping note with 24 hour events and adding A/P info. I tried going in blind the first day with no pre charting the day before and it took forever. Lol
very excited for whats to come!
So inspiring to see what it's like on the other end of the tunnel!
Exciting times! Happy for you conan.. keep up the great work!!
Also keep us updated on how ur workflow and strategy changes, interested to see how you can optimize things with time
i do pre rounds, chart rounds early in the morning then see all my 13-14 patients in one go. by 11-12pm, i do all my notes, consults and be done by 2-3 and go home
Wow used to be 15 back in my day at UCD. 13 sounds so chill. Usually seeing 12-18 plus admitting depending on the hospital. Lately been dialing back and signing up for "helper" shifts, can pick up a short list of 10-12 pts and get out in 4-5h and have almost a whole day free. Every patient after 12 seems to add exponentially more work/time
Yeah! They dropped the cap to 13 about a year and a half ago I believe. I can't imagine what it would have been like with 15 patients!😬 Those helper shifts sound pretty legit! Sometimes when I do finish early I still stick around until 4ish just in case something happens - but maybe I'll start feeling more comfortable over the next few weeks :) I also still write way too much haha so need to cut down on that. Did you ever get into dictating btw? Wondering if it's worth trying that out
sweet! congrats!
Is there a video where you talk about the business aspect of medicine. touching on negotiating your contract and scheduling and so on?
Dang, having 13 pts is really good as an attending! have you increased since then? I carried 10 as an intern on IM at the county hospital.
Our cap at our academic hospital is actually 13 which is pretty low and quite nice. It used to be 15. I think the average cap nationally is around 15-18
Sir how much do you earn now as a doctor? Plz reply. Thanks a lot.
Hi Doctor. Please help. I know you cant give specific details. My question...
Im an obese guy. At night my heart rate goes to low 50s. Made it through ARDS covid.... My ekg says RBBB and possible miocardio infarct with indeterminate age and my Doppler says diastolic heart failure. Any of these related to nocturnal bradycardia? Thank you!! 👍
Right bundle branch block with a possible prior myocardial infarction in that region could suggest you had a small heart attack on the right side of your heart sometime in the past, which supplies the SA and AV nodes that control your heart rate. You definitely should get a stress test to see if you have any coronary artery disease (blockages in the blood vessels to your heart).
The best way to treat your diastolic heart failure is with weight loss and managing high blood pressure which is the most common cause. Hope that helps!