1 / 28

Time Management

Time Management. Christopher Kasia , MD. Objectives:. How to chart review & create a task list Prioritizing post-rounds tasks and clinical problems Note Writing Approaching Sign Out. The Team. Attending Fellow Senior Intern Student . Many More Nurse Patient care technician (PCT)

fitzj
Download Presentation

Time Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Time Management Christopher Kasia, MD

  2. Objectives: • How to chart review & create a task list • Prioritizing post-rounds tasks and clinical problems • Note Writing • Approaching Sign Out

  3. The Team • Attending • Fellow • Senior • Intern • Student Many More • Nurse • Patient care technician (PCT) • Clerks • Case Managers • Patient Care Coordinators (PCC) • Social Workers • Transporters

  4. Characteristics of AWESOMESub-Interns • Efficient • Reliable • Anticipates • Eager • Honest • Inquisitive

  5. Professional Organized Punctual Role-model Is a Doctor Unprofessional Disorganized Late Slacker Just follows orders (blindly) Your “BEST” interns in medical school… The Good The Bad

  6. You’re here at 6 AM for sign out...

  7. Before you receive sign out Print a patient list of your team Use this as your “cover sheet” for the day This is where you’ll make check boxes / task list *All check boxes are not created equally*

  8. Your System • Organization, organization, organization • Find a routine and a system: • Trial and error • Give yourself extra time • 2 components to every system • Patient information • The daily to do list (check boxes)

  9. Patient Information Organization • Patient List • Progress Note • The H&P • Memorization • Bound to Forget Something • That’s OKAY! • Look it up and get back to us later • Senior and the rest of your team there to back you up

  10. Daily Checklist • One single daily patient list (IDEAL) • Single page is concise and compact • Easier to move boxes to new daily list • Must write small • Same Checkboxes for every patient every day • Vitals • Labs/lytes • Meds • Note • TASKS • Orders/consults • Sign Out

  11. Check Boxes / Task List “LMNOP” • L: Lytes • M: Meds (new meds or med rec -- MAKE SURE MEDS AREN’T FALLING OFF!) • N: Note • O: Orders • P: “Pass off” or sign up

  12. Sign out IS: To hear of acute events overnight on your patients To hear brief summaries of your new admissions (Presenting symptoms, triage events, likeliest diagnosis and current management) Suggestions for improvement (two-way street) Professional, without extra patient commentary unrelated to patient-care Sign out is NOT: To be shown up late for Time to have to have/hear an entire H&P (that’s what the notes are for. E.g. if they have pets, like blueberries, enjoyed the new Spiderman movie)

  13. Immediately Pre-Write Your Note Strategy: • Copy forward your previous note *WITH AMENDMENTS* • Print note (preferably without using tons of paper) • Take notes as you’re chart reviewing (reviewed in upcoming slide) *This way, in the afternoon/after rounds, you can update your notes easily

  14. Reviewing your data for rounds • Like a CXR or EKG, there is no RIGHT way to pre-round. But do it the same way every time. • Suggested: • Flowsheets: Vitals, I/Os, lines, +/- ventilator info • Read overnight notes: nursing notes, PT notes, SW notes • Results review: labs, cultures

  15. Rounds Happen

  16. Post-Rounds: What’s Next?

  17. #1 Consults #2 Orders #3 Continue your notes *Attend Conference*

  18. Note Writing

  19. Notes: “A note has never saved a life”“You don’t have to write great notes, you just have to write notes” Your job is to be a bedside learner, not a professional note-writer No esoteric notes w/ minutia *iCOMPARE trial (NEJM, 2018) found that interns in 2010 had only ~13% direct patient activities.

  20. Patient Name Date Service Subjective/24 Hr Events: Objective:Physical Exam Labs +/- Micro section New images Assessment: (2-4 sentences summarizing initial symptoms, your ddx, initial treatment and how they’re responding to treatment) *Some people will numerical list problems here* Plan: *Always Sign Note* Write your service and your pager # Notes: • SOAP

  21. Mr. Smith 6/6/18 General Internal Medicine 2 Subjective/24 Hr Events: No acute events overnight Cough started to improve yesterday after duoneb therapy started. Slept well overnight. Objective:150/80, 90 bmp, 18 RR, 98.7 F, 91% 1 L LFNC No new labs today No new imaging Assessment: This is a 66 year old male with significant PMH of COPD and unprovoked PE (2010) who presented with acute worsening of cough and shortness of breath. Ruled out for PE given recent travel history, and treated for likely COPD exacerbation, now improving. • Acute COPD Exacerbation Plan: • Continue duoneb therapy every 4 hours • Will finish 7 day course of levaquin (D#2/7 today) • Offered smoking cessation therapy resources, patient declined • FEN/GI: PO as tolerated. No IVFs. No scheduled labs.

  22. It’s afternoon, things have slowed down a bit…

  23. An admit or consult is just around the corner, let’s keep up our time management! We’re in the home stretch! • ALWAYS be working on sign out in drip fashion, not bolus fashion • Consider writing an updated sign out as soon as your notes are done (things are fresh!) • Follow up consults from the morning • MOST IMPORTANT: Stop by your patient’s room to see with your own eyes if the treatment you have prescribed is working

  24. Congrats! It’s the end of the day, but one more task...

  25. Sign Out Refer to do/dont’s of sign out.

  26. Questions?

  27. Your Team and Tasks • Break into groups of 3 • Review your patient list and share with us how you would prioritize your patient care when you walk in the morning from sign-out to rounds • How did you prioritize? • What was your approach?

More Related