Friday, February 22, 2008


Just doing my charts. 37 is the number of pages in the patient's chart who came in to have some propofol for a minor hardware removal. the records people reminded me that it is not the number of pages but the fact that each page had to be filled out by someone. This takes time and then the records people go through the chart to make sure that the people filled out everything correctly. This got me going to see how much was clinically revelent. Well, there is the history and the consent. Everything else was there becuase of some guideline or JACHO thing. I counted that 11 different people had written in the chart.

I asked medial records if the new EMR will decrease this. They said, it may decrease the amount of paperwork but it will still be the same number of people filling stuff out and instead of being able to do it in the or and bedside, they will have to find a computer and log on and hope it doesn't crash.

I like the people watching my patients to be watching my patients not trying to make sure paperwork is well cared for. Then again, on rounds it takes me 4 times as long to fill out the chart as it does to actually see and care for the patients.

1 comment:

SeaSpray said...

I think it is great you want the people to be watching your pts vs paperwork. It is mind boggling to me to see the amount of paperwork involved on one pt. The Happy Hospitalist has an interesting post up on why he feels there is a nursing shortage.

It almost seems that the hands on with the pts is a byproduct of the paperwork instead of the other way around. The pt is the incidental in the equation in the quest for being an ever elusive target from lawsuits. I suppose all the documentation protects the providers and pts and maybe keeps everyone on their toes but I hope mistakes aren't perpetuated because of the increasingly burdened time constraints to get all of this accomplished.

Just looking at the difference in The Happy Hospitalist's comparison of doctor's notes...yikes! If time is money...then it seems that in the effort to prevent lawsuits it comes at a cost in revenue for all providers with the time it takes and people employed to handle the extra documentation. A while back, WhiteCoat from WhiteCoat rRants also complained about the new JCAHO regulations for writing out an order vs abbreviations. Of course it is documented that people have died because of illegible writing on orders.

I never realized how administrative medicine is. I naively believed it was about the docs/nurses helping to facilitate healing in pts. You Dr Welby MD. He never had paperwork. ;)

I have yet to work with an EMR. The hospital I worked in got one after I left.

PPMD who visits urostream and the Independent Urologist loves EMRs and has explained how he is totally paperless in his office and could operate his practice from across the street if he has to. Interesting stuff.

One last thing. someone I know who works over at the hospital I have been a pt in was a trainer for the new EMR system. She told me a lot of people left because of it but I think some people just can't handle change. She's a nurse. her only concern with it was that she thought there was more of a likely hood for medication errors. Yikes! Who does that help?

Computer systems crashing? That has made me want to quit and go stand at a register or spray perfume on people in the mall. ;) not a good shift when those things happen.