Team Documentation Lindsey B Dolohanty MD Assistant Professor

Team Documentation Lindsey B. Dolohanty, MD Assistant Professor of Dermatology, University of Rochester School of Medicine and Dentistry 10. 26. 17

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

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

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

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

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

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)

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”

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