Workplace Efficiency: How to Get More Time Back

Heidi A. Posey, PA-C

Disclosures

October 04, 2022

One of the biggest complaints that healthcare professionals continuously have is with workplace efficiency and administrative burdens. Many clinicians, including physician assistants, are happy with their career choices but find that the paperwork is burdensome. It's not just a little bit burdensome either, in fact, many healthcare providers report spending several hours a day outside of clinic working on their EHRs. Once we get stuck in the same day-to-day routines and stress, it can be hard to break this pattern.

Building relationships and expectations with coworkers and patients as well as more efficient charting are two steps to help with getting home on time and spending less personal time charting.

I've worked in psychiatry for the past 13 years; I feel very fortunate that my mentor was a natural expert in efficiency and boundaries. Since I began in this field, I've been teaching others what I refer to as the Golden Rule of the Workplace.

This simple rule is that you teach other people how to treat you. Really what this means is consistency and clear expectations. For example, if you delegate a job or task, then proceed to do the job yourself, you just taught that person that they don't need to do it. Though it may have been easier for you to do it "this one time," you've set a standard, and once a standard is set, it is hard to go back.

By not being consistent with communication, expectations become muddled. This doesn't mean don't help when needed, but to be aware of if and when you are creating more busy work for yourself.

Team Huddles

On a day-to-day basis, team huddles are proven to help with interprofessional communication and teamwork. You can encourage your team to ask questions, be more prepared for the day, foster healthy team-based relationships, and clarify expectations.

The Agency for Healthcare Research and Quality offers a toolkit that explains what huddles are, how they can be beneficial, as well as how to get them established

My Golden Rule of the Workplace also applies to your relationships with your patients, which can be applied with your very first encounter. At the first meeting, I always tell my patients that I will give them enough medication to get to the follow-up appointment, then have them schedule the follow-up before the end of the telehealth appointment or before they leave the building.

I also let them know that if they can't make it, they need to call to let us know and to ask for refills if needed. I also tell them the days that I'm in the clinic, days that I'm not on call, and that refills will only be filled during my normal clinic hours. Then, when they miss an appointment, they have been told it is on them to reschedule and ask for refills.

If you find yourself inundated with refill requests, unnecessary calls, or emails when you are supposed to be off, ask: "Have I taught other people to have these excessive expectations of me?"

Why We Chart

So how do we spend less time charting and working from home? Let's go back to the basics of why we chart. There are essentially three main reasons: first, so you know what you were thinking when you see the patient again; second, for a colleague or other clinicians to know what you were thinking and when they resume care if necessary; and third, liability.  

Using templates and dot phrases or keyboard shortcuts are the most common suggestions to help with charting efficiency, but there are other approaches that can be helpful as well.

When I do assessments, in a specialty, I note all the previous medications that a patient has tried and their responses or any adverse reactions. I also note a list of medications that they haven't tried. I keep these lists in a part of my chart that carries over for each note, so at each appointment, I do not have to go back into several charts just to see what was tried. I already have a list of medications to consider on the basis of previous medication responses.

In addition, I always make a note in my plan for what I would do next time if what we did today did not work. This helps with pre-charting for the next appointment as well as if a colleague or someone else resumes care. It eliminates, or at least reduces, redundancies where possible.

If a patient reports symptoms and you document that in the history of present illness (HPI), are you repeating the report in the review of systems (ROS) in such a way that it is redundant? Could you note in the ROS to "see HPI" or pull the information from the HPI instead of typing it all out again? This helps you be conscious of how you are documenting. If there is a more concise way to chart using templates or other forms, take advantage of these tools.

Liability is really the sticking point. We never want to cut corners here; it is essential to have all the information that is necessary documented. This goes back to the old adage: If you didn't document it, it didn't happen. 

How to Bill

You can also pre-chart, which I strongly encourage. Since 2020, according to the Centers for Medicare & Medicaid Services (CMS) and American Medical Association guidelines for evaluation and management coding, you can bill either time-based or by medical decision-making. If you are billing time-based, the time spent on the patient that day can be included in billing time. That means that pre-charting time is included. The time includes work done before, during, and after the encounter, according to CMS. This may be beneficial in some specialties, but more importantly to the topic at hand, it helps the clinician be more prepared and thus more efficient.

Precharting takes a short amount of time and helps prevent you from walking in unprepared. It gives you a chance to review the notes and means that you can start to develop a potential game plan before the patient is ever seen. It also gives the provider time to review any other consultation notes, labs, images, etc.

If you find that you are struggling with the IT aspect or knowing how to use the system, do not hesitate to reach out to your administration for more training either. Remember, they want you to be more efficient, and most of them won't hesitate to make that happen.

We love what we do, but medicine is a very demanding job, regardless of your role. Unfortunately, many of us wake up one day and realize that we are drowning with the extra work and question how we got to this point. Having clear expectation and boundaries with your work team and patients as well as brushing up on EHR efficiency are two options to being able to have more time in your personal life and joy in the workplace.

Heidi A. Posey, PA-C, specializes in child, adolescent, and adult psychiatry and is co-founder of the nonprofit The Burn Clinic, which offers education, prevention, and treatment of burnout for healthcare providers.

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