Morning Workflow

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Mornings are crucial your success. Use this time wisely, and things will fall into place. Waste this time, and the day will quickly fall apart. Although somewhat attending dependent, generally you should be ready to go by Unit Based Rounds at 9:30 AM.

Prioritization

  • Resident time is valuable and finite. It must be carefully managed. You will feel the pinch on clinic day, lectures, morning report.
  • Keep a To-Do list. Use it. Whatever works for you.
  • Sick patients should take priority over everything else.
  • Discharge patients take next priority as discharge is a time sensitive event that is often dependent on services or facilities that may only operate during business hours.
  • Transfers and admissions are also important as they free up valuable resources such as the ICU or Emergency Room.
  • Generally, anything that depends on another person or service should be done sooner, rather than later. This is both polite, and in the best interest of the patient.
  • This usually means prioritizing calls and consults over other tasks and responsibilities.
  • Orders are time sensitive. Put these in first. Give verbal orders if needed, but do not forget to sign these.
  • Notes are important as they communicate the plan of care, but they often can be delayed without issue.
  • Call the lab. If something is taking too long, or you need a culture result for discharge, call the lab. This will help.
  • Communicate with case management and social work. Develop a strong working relationship with these people.
  • Remember, if PT/OT does not see the patient, case management cannot send the referral. If the referral does not get sent, then the patient will not go anywhere today, and probably not tomorrow.

Chart Check

  • Use a scutsheet or similar tool to track patient data. Commonly used templates can be found at Medfools. Upper level residents also have many personal templates available.
  • Record data including vitals, labs, medications, imaging, micro.
  • Review notes and recommendations from nurses, PT/OT, support services, consultants.
  • Although the small details are important, do not forget the the big picture. You still must be able to communicate the story/narrative.
  • Know and track home medications. Someone will probably ask about this.
  • Printing out the "medicine sign-off" report or even the full H&P can be helpful in a tight pinch with new patients.
  • As efficiency improves, it is likely that less information will need to be recorded.

Start and Pend Notes

  • As each patient is reviewed, start a progress note.
  • If the patient will be discharged, start a discharge summary instead.
  • As efficiency improves, chart review and note writing may start to become more integrated.
  • Work on notes at every opportunity whenever appropriate, while pre-rounding, in the patient room, during rounds.

Regarding Haiku

  • Haiku can be a powerful tool when used for rounding.
  • However, it also suffers from major drawbacks including significant lag, repeated need to log-in, improper display of labs.
  • The app still lacks the ability to manage orders or edit pended notes.
  • Haiku very recently added the ability to display pended notes. This is a big deal.
  • Feel free to experiment with Haiku as a rounding or chart review app, but be aware of these limitations.