As a soon-to-be-attending hospitalist, you’ll shortly be on your own directing patient care. According to SHM data, you will see 12 to 18 patients per day, if not more. You understand the medicine, but how can you optimize your day to make it home in time? Here’s how you can direct your workday more efficiently.
1) Organize: This should come as no surprise. This crucial skill, reiterated during residency training, will prove invaluable as a practicing hospitalist. It certainly helps to maintain a structured and accurate daily census. Keeping a list of things to do handy and refreshing that list keeps you from having to rethink or reread your notes. On some occasions, doing things rather than writing them down to complete later can be faster. Whether you utilize handheld PCs or note cards, find a method that works for you.
2) Plan your day: If you know you are going to have a busy day, accept it. Start the day with a positive attitude and know you have to keep moving and can’t get stuck on trivial things. See your sickest patients first, or the ones you know will require a lot of time. Also, see your potential discharges as early in the day as possible to optimize the discharge process and pinpoint potential problems. If you are the attending on a teaching service, spend time with your resident to go over the structure of a typical day.
3) Consolidate: If you have patients in different areas in the hospital, start with the areas where you have the most patients—especially the sickest ones. See all the patients in proximity to each other. Avoid running between the computer, the chart, and the patient’s room for every patient. Lump some of these tasks together and avoid losing time.
4) Avoid hold music: Instead of paging people and waiting for a call back, send a text message to increase your efficiency. Try to contact (and wait for) someone to call you back while you are doing something productive—like writing a note. You can also make other work-related calls, such as to families and consultants, during your commute to or from work. This saves you some time when you are in the hospital.
5) Delegate: A lot of new hospitalists have difficulty relinquishing control—similar to when they made the transition from intern to resident. As an academic attending, don’t micromanage. Rather, attend to the global issues and problems that might need a greater degree of attending involvement, such as challenging family situations. This requires a certain degree of trust in your resident.
Assign specific responsibilities to members of your team (residents, interns, and medical students) and go over their roles. If you are not at an academic institution, you can still delegate tasks like procedures (central lines, spinal taps, thoracentesis, and paracentesis). There are other specialists in the hospital who perform these procedures more frequently and more efficiently than you.
6) Give yourself a time limit: To improve efficiency, some people find it helpful to give themselves a time limit to get their work done. Making this time limit practical may help get you home at reasonable hour. Also, learn to gracefully extract yourself from chatty patients, family, or colleagues if time is short.
7) Document efficiently: When rounding on patients, make sure the note is written when you see the patient—then move on. You can always come back for an addendum if needed. Group your note writing as much as possible on each floor. When admitting or discharging a patient, do all documentation at once, including notes and orders. This way you don’t waste time getting back to information you have in front of you. If there is a history and physical available on a new admission or consult, print it out and use it as a template during the patient interview. It helps to confirm details with the patient and fill in gaps. If time permits, prepare discharge papers and prescriptions in advance of anticipated discharges to save time on the day of discharge.
8) Define inpatient vs. outpatient management: Differentiate between important inpatient workup and evaluation that can be performed on an outpatient basis to save time and reduce length of stay. When patients can safely leave the hospital to continue work-ups and follow-ups with their primary care providers and specialists, you gain more time the following day—when you are no longer rounding on them.
9) Schedule a time to see family members: Conversations with family members are usually more productive if those times are scheduled. If possible, schedule them after you have seen a bulk of your patients to avoid feeling pressured to cut the meeting short. It is important to know who the family spokesperson is for large families so you can refer other family members to them and avoid multiple call-backs.
10) Develop and maintain good relationships: Your cordial interaction with various hospital department staff (nursing, case management, social work, radiology, and physical therapy to name a few) will help facilitate the inpatient care plan. It certainly helps not to have to wait two or more days to have a diagnostic test performed or assessment made. Sustaining a healthy working relationship promotes an understanding of your expectations for inpatient care.
11) Advocate for constructive change: Much inefficiency is systems based. Thinking about what interferes with your effectiveness in your system and suggesting changes can help a lot. For example, if your institution is going to switch to an electronic medical record, it certainly helps for you or a member of your hospitalist team to get involved in the implementation. Many hospitals are invested in quality improvement—and hospitalists are and should be at the forefront of this change.
As a hospitalist, you can initiate changes within your practice and your hospital’s system to keep things efficient. Making those adjustments sometimes takes time—but they’re well worth the effort.
Meanwhile, maximizing your efficiency can help promote patient throughput, enhance patient satisfaction, improve quality of care and increase job satisfaction. TH
Dr. Magnet is a hospitalist at the Singing River Hospital System on the Gulf Coast of Mississippi and a member of SHM’s Young Physician Committee.