Transcript The Efficient Clinical Session

The Efficient Clinical Session
October 14th, 2010
Peggy Chou, MD
Craig Noronha, MD
Section of GIM
Objectives
At end of this seminar we hope that providers can
1)
Work more effectively during their clinical sessions
2)
Manage patient interactions more efficiently
3)
Develop advanced logician techniques
What makes you slow down in the
clinic?
Current Reality vs Dreamworld

BMC is NOT getting a new electronic medical
record system in the near future
 Electronic medical records are NOT going to
disappear from the United States health system
 We are being asked to see more patients with
more medical problems in shorter periods of
time
 Our patients problem and medication lists will
get longer as they age and acquire medical
morbidities
So what can we do????
 Develop
Habits that allow us to be more
efficient in clinical settings
 Use
our clinical interactions with patients
more effectively
 Use
the EMR system to our advantage or
at least speed up what we are doing
Helpful Habits
Make the chart easier to focus:
-
Reorder/Clean up medication and problem lists
-
Add comments to medical problems to help you
in future visits
-
Add titles to visits i.e. visit for knee pain
Being Proactive
 Look
at the patient’s chart BEFORE you
sit in front of the patient.
 Looks
up labs, review ED reports, other
provider visits etc
 Start
placing orders before seeing patients
Show up early
 You
cannot control if the patient or staff
are running late. BUT if you start late you
will never finish on time.
Do only clinic work during sessions
 Do
 If
not check emails or web browse
you have down time- sign notes, sign
forms, review patients for tomorrow etc
“Do Today’s work Today”
 The
longer you leave notes the longer it
will take to finish them
 If
you see labs that are normal– do a quick
follow-up letter.
 Use
a results letter/form in logician
Do Not Leave the Room Unless
You Have To
 Page
the staff or call them if you need to
 Minimize
interruptions by negotiating with
staff up front
In the room…
 Computer-patient-MD
triad
 Setting the agenda…..and setting limits
 Letting go…
 Refresh
Working with the computer
 Most
efficient if type while talking with
patient
 Position computer if possible
 Acknowledge the computer, apologize if
necessary (especially if positioning is less
than ideal)
Setting the agenda…setting limits
 Negotiate
agenda up front. This allows
you to set limits later
 Let the patient control as much of the
agenda as possible
 “In the time that we have….” “We need to
stop for today…”
 “Do today’s work today” BUT balance with
continuity of care
Baker, LH et al “’What Else?’ Setting the
Agenda for the Clinical Interview” Annals
2005 143 (10): 766-770
Letting go…
 Patient
in control of the agenda
+
 Staff in control of the flow
=
You can focus on the patients
Refresh
In the middle of the session, take a 2 minute
break:
Quick walk
Snack
Etc
Logician Tips

Quick text- how to make one and use one

Using previous notes to your advantage

Flag management

Result management

Organize medications and problem lists
Quick Text
htnros
=
Patient denies any headache, blurred vision, chest pains, shortness of breath, orthopnea,
or leg swelling. Patient reports that she takes all medications as directed.
How to “future” flag yourself
Flag yourself WHEN you need to worry about
something
 Helps prevent “overflagging” so that you loose
track of important things
 Good way to remind yourself about following up
on patient’s studies, outcomes, visits with other
providers etc
 Good way to remind yourself to ensure that tests
got done ie CT scans that need repeating etc
How to manage results???
 If
you have several results for one patient
sign all but one of them- makes your
desktop look cleaner
 Result
letters- use them to your
advantage for stable or normal results
 Call
the patient only if you have to
Organize your Medication and Problem lists
 Place
the highest priority or cannot miss
diagnoses/medications at the TOP
 Place less important
diagnoses/medications at the bottom and
indent them
 Add comments to your
diagnoses/medications
 Remove old resolved diagnoses ie URI in
2004