First, a VERY important note/disclaimer that these tips are NOT to suggest that those struggling with too much clinical responsibility or burnout or moral injury etc can fix everything with a few productivity hacks. I do not want to minimize the fact that many people have a true work overload issue and may be pushed to the max already. Still, for others it may be helpful to optimize a few things so I am sharing these ideas today as they have helped me personally.
The Why: feeling less behind –> burnout prevention; ability to focus better on each patient without feeling rushed –> patient safety and just an overall more pleasant experience for both patient and provider.
IDEAS DISCUSSED IN THE EPISODE:
B+ notes. Not suggesting to be inaccurate or purposefully incomplete. Just suggesting you put the most attention into the most critical parts for patient care (the assessment + plan) and less into the rest, and to make sure you are up to date with current billing-related documentation requirements as it may actually save time.
If at all possible, finish each note before going to the next patient. Not always possible. But sometime it is!
Constant inbox grooming when/if there happens to be a lull. First patient taking a while to get roomed? See how much of your clinical inbox you can handle. Yes, it’s task switching to some extent. But I’d rather do it during clinic hours than later on, and I really think emptying your clinical inbox on a very regular basis ends up saving time (and making patients happier!) in the end.
Pre-write notes while patients are being roomed (even before you attack the inbox!) and use that time to review what is happening with each follow up + review records for each new patient.
On the inpatient side, pre-round thoroughly! You will save time by really taking your time to review labs / notes / prioritize. Do not let feeling like you have to GO GO GO to be efficient prevent you from preparing adequately. Pre-rounding can also help you go in a mindful order that may save time/effort in the end.
Set expectations with patients for when labs result, when/how they will be notified, and how they can ask questions via the electronic portal. I have reduced my ‘results phone calls’ by probably 80-90% by really emphasizing use of the patent portal. That said, if you find the conversation starting to become a back and forth chat, set up a telehealth or formal phone appointment. (I can imagine portal use might be more challenging with older patient populations, but hopefully that will continue to improve with time.)
Chat functions, like EpicChat: set expectations there too! Non-urgent requests (ie, something that could be handled in a few hours) should NOT be interrupting you mid-visit. Discuss (gently) with individuals who do this why it’s better if they use another modality such as an asynchronous staff message.
While in room, I type out the plan while explaining it to the patient, and this serves two purposes – it goes in the after-visit instructions that gets handed to the patient AND it’s pasted into my plan in the note. Less confusion, and it’s one less part of the note that needs writing after the visit.
Don’t waste effort – make a dot phrase! Make sure you have a helpful library of phrases that expand automatically (I am sure other EMRs do this; in EPIC it’s called a dot phrase). If you find yourself writing something frequently that’s a signal it should be a dot phrase. Even logistical instructions (ie about when / where patients will receive results, or my recommendations for adult endos for those who age out) are dot phrases.
Look ahead but not too far. Don’t get bogged down and ruminate on patients scheduled months out. I used to do this. One day at a time feels more manageable. That said, looking ahead a week or so can be helpful and if possible have an assistant call patients to ensure they have completed labs and that we will have access to what we need for the visit.
Plan vacations in advance! Gotta have things to look forward to! Schedule placeholder vacations if needed!
Ask for help – don’t drown. If you are already very efficient but the workload is just too great to do your job in a reasonable number of hours/week, ask for help! I think in that case it would be very helpful to quantify how you are spending your time at work so you can a) provide objective data and b) see where the pain points are (doing more admin-type work that could be done by others? just too many patients? etc).
Very interested in hearing thoughts and for you to share your own favorite tips! I also wonder if/when AI might help make a lot of this note-related advice irrelevant — which would be great!! I just attended a seminar where they marveled about AI-generated graphics but then suggested manually calculating every minute spent in a patient room/documenting/etc. Sigh . . .
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