1. EFFICIENCY AND ORGANIZATION INPATIENT CARE CONTRA COSTA REGIONAL MEDICAL CENTER

2. TIME SQUARE METHOD SickNot Sick Difficult+++++ Not DifficultNeutral--

3. USING THE TIME SQUARE Estimate the visit length within the first 30-60 seconds of the encounter Use the time estimate to either prepare a longer agenda and/or engage in “ limit setting ” Give the patients the time they NEED Remember the majority of patients are not “ difficult ”

4. PRE-ROUNDING Use time wisely: sickest/new/dc patients first Copy previous days note and *** things you need to change Let your note write itself: template collects vitals/labs for you vs. only collect sig vit/lab/etc. Start to-do list (AM labs/ daily note/ sign-outs/ important PE follow up) Refresh note before rounds to include AM labs Collect thoughts (big picture vs details), or read a little, for assessment and plan

5. ROUNDING Set an agenda (sickest/new/dc patients first) Open note and finish while discussing  Double screen  ‘Sign’ as you finish each patient Write orders while rounding  Or have your attending write the orders Call consults during rounds  Pager/phone list on badge or open Scoop nearby Update to-do list (red pen or * important) Discharge med rec’s while with an attending

6. AFTERNOONS Free for procedures, discharges, admissions, family conferences, more detailed history, update sign-out notes Sign-out at to HO/ICU resident at 5:00!!  Find a quiet space to finish up without distractions Go home!  The longer you are in the hospital… the longer you are in the hospital

7. GENERAL Make a Schedule: and stick to it! Batch your activities Delayed gratification system Systematic approach Organize your workspace (protopage.com) Complete dc summaries the day of discharge (dictate!) Delegate/ask for help/let someone know if you are struggling! Minimize interruptions (screen pages/quiet space for notes/rounds) Self care: exercise, sleep, eat, etc. Finish every activity you start Call translator service on your cell while walking to pt room Keep asking “is this the most efficient thing?”