I'll add to this:
the biggest thing is trying not to sign stuff out, waiting for that last consultant to call you, ct to be read....etc. at our place whoever signs the chart gets paid. you burned 3 hrs taking care of a guy, not to mention all the liability just to sign the pt out and now get nothing. this is the most common problem
finish charting/defensive charting.
MLP chart review is a huge time suck. I get about 25 or so per day. even at skimming 1-2 min per chart. well you get the idea. and god forbid you find something really jacked up that requires calling the pt to check up on them
that brings me to pt call back. I do a few every now and then. some shops require you to do it!!
worse is the sick bastard that arrives 505am at the tail end of your 9p-6am shift that may require a transfer. there's no starting it up and signing that out
The underlined, all the time. It drives me nuts. 1-2 minutes per chart x 30 charts a shift = 1 hour. Damned if I'm going to do this on my "own time" and not get paid. I have close to 50 in my queue right now. I'm off for a week. Eff that noise. I'm gone.
The other half of this annoyance is the MLP end-of-shift two-step, where you're 15 minutes until leaving and all your patients are tucked away, but then MLP1 and MLP2 come to you and say "Hey, I have to ask you about this one" - and they want you to make decision based upon a workup that, frankly... sucks. Worst is the T-minus 10 minute "dizzy senior" patient.
"Are they orthostatic?"
(I didn't order that)
"Did you walk them?"
(Well, no, not yet)
"Any cerebellar signs?"
(What do you mean)
"So, why do you want to send them home?"
(Well, the BNP is only 3000, and I know thats meaningless, but...)
"Are they anticoagulated?"
(Well, they're not on Coumadin, but they have a history of a-fib)
Our director sent out an email several months ago that said in bold and underlined font...
"Patients should be staffed with the supervising physician at the beginning of the encounter. MLPs should not consult physicians for the purpose of making a disposition."
You think those MLP'ers listened for a second? Nope. I even brought this up to one repeat offender (who feels the need to "check every patient 'out'"), and her reply was - "What email?"
Full disclosure: I don't want to "hate on the MLPs". I have worked with many that are top-flight. But more and more of them get "minted" every year - and they seem to be comfortable to not
learn anything after they graduate. The general attitude is "okay, I did my joblolz now you make a /decisionk?" - ....
NO! Is my general response. YOU can do this. MAKE a decision. DOCUMENT your reasons why. STAND by your decision making with good evidence. THEN tell me what you want to do and why.
Don't let me catch you coming to me saying "Well, if conditions x-y-and-z are satisfied, and you think its okay, then I want to (....)".
Then, when I read the chart, X-Y-and-Z are nowhere to be found.