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