Charting in the room can help you, as a physician, stay on track, improve patient care, take less work home, and make a difference in your workflow. It’s possible, and you can make it happen by charting in the room, finishing notes in the room, and coming prepared to go from room to room, patient to patient.
Leveraging electronic communications will indicate things have been done, empowering the staff to take care of some things more quickly.
The principles of charting in the room work for all physicians, even those in procedural specialties or primary care. These principles, however, are part of continuous growth and improvement.
Join the conversation with your host Dr. Ryan Stegink as he shares more about how charting in the room can improve clinical efficiency, patient care, and physician wellness.
During this episode, you will learn about;
[00:01] Introduction to the show
[01:52] Today’s focus: Clinical efficiency and charting in the room
[03:22] Appreciation and the WHY for this podcast
[04:06] Analogy for efficiency; A story about Dr. Ryan back in high school sports
[05:30] Charting in the room
[09:25] Finishing notes in the room when you can
[10:30] How bringing fewer notes at home helped Dr. Ryan stay on track
[11:30] Coming prepared and going room to room when possible
[14:42] How to tweak different feelings that come with charting to make a difference
[16:29] Taking the next step to get better at charting and feel better about it
[16:54] Ending the show and call to action
Want to get home sooner from clinic or the hospital? With all your notes and charting done, too? Get your FREE PDF guide with 10 tips to maximize your clinical efficiency! https://www.mededwell.com/efficiencyguide/
- Finishing notes in the room will help you bring less work home
- Doing orders in the room can create a shared understanding that empowers the staff to take care of some of the things in advance
- If you feel constrained, overwhelmed, and losing control, hold on to feelings of empowerment, relief, and confidence
Connect With Dr. Ryan Stegink
Above are the episode show notes and below is the transcript. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!
Have you felt exhausted in medicine? Like your practice is more like a treadmill than truly a calling? Is the charting weighing you down? Working well past your last patient of the day, charting at home, in the evenings and on weekends. The notes and paperwork, lab results, quality metrics, all the things, right?!?
What if I told you there were some ways to make a change, to get more efficient so you can finish work at work and have the margin to intentionally choose thoughts and actions consistent with your values and priorities? You can get my free guide with 10 tips for getting work done at work more efficiently. Get yours today at www.mededwell.com/efficiency
After that, if you know that you want to take a deeper dive into your thoughts and clinical practice, check out MedEdWell coaching with Dr. Stegink. Fight burnout and moral injury. Find fulfillment and create margin by examining your thoughts and actions to take that next step forward from where you are to where you want to be, aligning your actions with your priorities. To find out more and to book a consult, head over to www.mededwell.com/coaching.
You can also find that link in the shownotes of the podcast player you are listening on right now.
And now for the rest of today’s episode.
Thank you so much for joining me here on episode 36 of the MedEdWell podcast today, we’ll be talking about clinical efficiency and charting in the room. It’s maybe something you hadn’t thought about much before, but it’s just really important to say, Hey, how can we make that next step? And maybe a way that you didn’t think about before, or maybe you’ve been doing it and an opportunity to tweak that and make it more efficient for you. So this is part two in a six part series on efficiency and improving clinical practice. Last time we had an overview of charting and efficiency and kind of more of the why behind things, but today we’ll be talking about charting in the room, finishing in the room and going room to room. These principles still definitely apply to those who are in procedural specialties. It’s just as a primary care physician.
This is how I’ve experienced it and conceptualized it. So with all these things about taking your next step in a way that fits your life and your workflows, before we jump in, though, I wanted to thank you for continuing to show up, to listen, to share these episodes. And for all you do as a physician, I show up here because I want you as a fellow physician, to be able to make a difference in your life or the sake of your patients together, we can impact so many people. We have to care for ourselves. So let’s jump into today’s topic about charting. So first little story taking you back to my high school days, it’ll relate and just stick with me. So I was in marching band and soccer in the same season. Thankfully, both activities were gracious and allowed me to participate. No, I was not in the drum line, go perform like it was its own sport.
I, we still got to do some marching at the football games. And primarily my school did a couple of parades, even got to travel to Florida but we marched in a downpour. We played the Beatles yellow submarine. I digress. So I did marching band and soccer and sometimes soccer would be after school. And then marching band would be in the evening. Sometimes I’d come home, but many times have to bring a bag lunch and have to eat and then run to marching band, bring a change of clothes. And this allowed me to go from one to the other more efficiently. So this is kind of an analogy for how, if you’re prepared, you can go from room to room. So we’ll get to that in a moment. But first for today in talking about these efficiency things, I wanna talk about charting in the room. So you walk in, you say, hi, I’m Dr Stegen. And it’s important to sit down, to make eye contact as much as possible. And hopefully you have some sort of ergonomics in your setup. Some of the rooms that I’ve seen patients in might have the computer basing away from where the chairs are where the patient or the patient, their parent will sit. Certainly good typing skills, help. We’re gonna chart on the computer in the room, but really anything that you can type in the room is good. Use some shortcut keys. If you can, some
Templates, some preference list. Really, there are so many little things that if you take a moment to sit down and say, where am I? And where’s my next step. Really? There’s always room to change or to optimize next things about taking your next step. Because I have some training in optimization in the electronic medical record that I use and I’ll hear one of my colleagues or someone else saying, oh, I wish it would do this. And I know that, oh yeah, it can do that. Let me show you sometimes having three or five different ways that you could do something. You just, if you don’t know, you don’t know. So I enjoy sharing some of those tips, but again, you don’t necessarily have to have them all right away or at all be able to make progress. So while you’re charting in the room, it’s important to also look at your visit diagnoses and orders.
If you can get some of those set up in advance, you know, they’re coming in for this, you know that they have this on their problem list and you’re going to address it regardless. Maybe you put that in there either before go in the room, or right as you’re sitting there starting to enter their orders, maybe you can customize a preference list. Maybe you have some sort of order sets or bundles of orders. Mm. It can be as easy as prompting you for some of these decisions by having them preloaded, because you talked about it with your staff. Maybe there can even be some clinical decision support, as long as it still lets you make clinical decisions as their doctor. Another thing, while you’re in the room, it can be really helpful is to put pertinent exam findings. I have a child that has an ear infection, at least putting that their right ear, their right Toan membrane was bulging.
And AOUS, opacified, that’s really helpful as I go back to, to document and to finish up my notes. So first charting in the room, but second, I want you to consider. And again, some of these things are initially aspirational, but ultimately I want you to get there and full disclosure. I don’t always myself. So that second thing is to finish notes in the room when you can, it’s helpful to sign orders for the staff while you’re in the room. And maybe if there’s a way that it electronically communicates with your staff, or there’s a visual indicator that something is changed, the orders are signed. Then you can stay in the room for an additional two to three minutes and many times by staying in that same mental state of focused on that particular patient, you can often finish the note in the room. I’ve started to do this and I’ll just let the patient know that the staff already has the orders.
They’re getting them ready and I’m not holding up the flow of their visit by sitting there and doing the rest of my note, it’s helped me bring less work home. And I tell them that a happier doctor brings less stuff home and is good for patients. I found this really helpful when I was thinking that prior to my opportunity leave, I could potentially be called away if my wife were to go into labor at any moment. And so I really tried to stay on track and up to date because I didn’t wanna have a bunch of notes. If I suddenly had to leave often, I don’t finish my note in the room if I’m running way behind. And this is I think a mindset thing that I need to work on myself, but especially if there are multiple siblings and it’s really chaotic, or the patient continues to wanna talk and share about other issues that maybe are triaged a little bit less important or for a subsequent visit that maybe could be even a week from now, I’ll step out.
But it’s about saying, all right, if I considered that it could be possible. How could I go about making that happen? So first charting in the room, second, trying to finish notes in the room. And then third, this relates to the story of coming prepared, going room to room when possible from patient to patient previously after each patient, I’d walked back to the room, I’d check in with my staff, I’d log back into the computer and maybe try and finish my notes or orders there. I don’t have badge tap access. I still would be doing more steps and it takes time. I’m also a social person. So I saw some of my colleagues or someone had another piece of paper for me to sign or to review. It just adds a going room to room when possible, even just a few times a day can be helpful, again, less walking or streamlined.
And by using a pre-visit planning time, talking with staff and huddle, it creates a shared understanding that empowers the staff to take care of some of the things in advance that we know we’re gonna be doing developmental screening for autism at 18 and 24 months or some other developmental screening at particular ages. It just makes things go more smoothly. Also by doing the orders in the room, it has some electronic communication indicating that things have been done. And I can also put on there when I want them to come back. And another thing that’s been really helpful has been pending some of the letters, the communications that I want for the patients, whether that’s a particular physical form or a customized excuse for school when they can go back based on their current illness and because just how the printers are mapped, sometimes it may not go or you think it goes, or the staff may not know that it’s been printed and to pick it up.
So by putting in a request to print that penned letter, it allows them to collect all of their checkout paperwork together in a way that ends up streamlining things. Again, it’s something that’s a continual work in progress, but considering that it’s possible allows you to then say, if I did this and it worked, how would I feel? Cuz really there are so many different feelings that come with charting, which come from our thoughts. I can’t finish my notes in the room at a particular time. I can’t chart in the room. I can’t go room to room. There’s something else that I have to communicate. There are still some of those exceptions, but by building new workflows, tweaking things just a little bit reflect on your clinical practice, just consider how would that affect things? How could that make a difference for you? How could you be curious
And try a different thought? Maybe tell yourself I can chart in the patient room. I can finish my note in the room. I can go from one patient room to another and then consider how does that make you feel? Does that feel empowering? That feel great? Maybe it feels like a little bit of relief. Some of the thoughts that in feelings that I’ve experienced, I’ve been around, I can’t get all these done. I feel constrained. I feel overwhelmed. I feel like I have a loss of control. I’d much rather hold on to those feelings of empowerment of relief of confidence. So I want you to consider what your next step is in charting and efficiency, workflow optimization. It might just get you done faster with charting and feeling better about it as you examine your thoughts. Thank you so much for joining me here on episode 36 of the mededwell podcast. I want you to share this episode with a colleague, with a friend, with a physician in your life who, you know, would benefit from this, let them know that this is something that we can all work on and it’s a struggle that it doesn’t always have to be as we take those next steps forward. Go back next time. And I look forward to continuing on this journey of helping you with your wellness as we encourage one another to take that next step forward. Thanks for all you do and have a great day.
And now for our important disclaimer:
Dr. Ryan Stegink is a practicing general pediatrician, but the MedEdWell podcast does not reflect the views, opinions, or beliefs of his employer nor affiliated university. Additionally, the MedEdWell podcast is for educational and entertainment purposes only and should NOT be considered advice regarding financial, legal, student loan, medical or any other specific topic. In such a case, you should seek consultation with a certified professional in that particular area. Again thanks for joining us on the MedEdWell podcast, and have a great day!