Team Documentation

1. Team Documentation Lindsey B. Dolohanty, MD Assistant Professor of Dermatology, University of Rochester School of Medicine and Dentistry 10.26.17

2. Why team documentation • Young attending • Spent 4 hours after full day clinic “just catching up” from that day • Unable to use scribes (2014)

3. What/who is it: • Attending • 2 LPNs • 1 clinical technician • +/- resident **Formal job descriptions for each

4. Where/When important: • Outpatient clinics • High throughput specialties • Dermatology • Potential for multiple unexpected small procedures/wound care

5. How: • Templated note • 200+ smart phrases created by attending physician • Teamwork • Approved by compliance • Direct observation • Notes reviewed • URMC approved attestation of notes

6. Importance: • Avoid attending physician burnout • Reduce physician work “after hours” • Increase efficiency/avoid delay in clinic • See additional patients

7. Goals of TD: • Maximize use of all team members • Engage all team members in patient care and thus ability to include them in personalized after care • Greater job satisfaction for all • Attending takes full responsibility for everyone on team • Maximize face to face time (attending-Dr)

8. Limitations of TD • LPNs have limited specialty knowledge • Patients/situations arise that don’t fit a template • An experienced resident + attending is faster than TD LPN + attending in difficult situations • Residents are in clinic to learn as much as they are to “work”

9. Limitations of scribe • Can’t touch patient • Procedures • Bandaging/wound care • “Stranger” in polo shirt can be intrusive to patient in gown wanting full body skin exam • Outpatient rooms small for “extra personnel” • Can’t obtain patient consent/numb patient