We all face the challenge of being efficient in our practice of medicine, as well as being humanistic with our patients. This becomes evident in the office setting and in "rounding" in the hospital. It is possible to be efficient in our work without cutting corners and to have more time to get to know the patients we serve. We preface these suggestions by acknowledging that all teams and models in the healthcare system are different and vary in nature. Therefore, the strategies and tips mentioned here may not always be the most efficient, depending on the particular situation of your practice. Nevertheless, several key principles are characteristic to being efficient and using time effectively during rounding.

Plan Ahead

An efficient team anticipates what may occur during the course of the day and what pitfalls may present that could interrupt the flow of the day. When an admission is mentioned, gather the paperwork needed for the admission, scan the computer for old records to fill in information, and get to the emergency department with at least part of your admission note already done. This will help you to get a patient admitted faster and allow you to spend more time to get to know more about the patient's general medical condition. This extra time you gain by becoming more efficient also enables you to access clinic notes and review records that will give you a sense of how the patient's health has evolved and possibly review notes that include details of the social information the patient may not put forth at a brief emergency department admission. Once the person is admitted, start the discharge paperwork, discuss the long-term plan for the patient, and keep case management well informed, so they can prepare discharge planning. Always using those few minutes of downtime to think ahead and determine the long-term plan is key to being efficient.

"Pretemplating" the daily progress note for the next day is another part of planning ahead that can save time. When doing so, leave subjective comments, key physical examination sections, and any active problem on the list open for filling in while rounding. Nothing is set in stone in a template, but it helps you to hit the ground running in the morning. In addition, by writing down your plan for the patient, you have committed on paper what the plan for the day is. The daily notes could be filled in by another team member, while someone else asks the patient questions, or they could be finished while someone else writes the orders. Making rounding a team effort is also a key component of being efficient.

Be Intentional

Be intentional about all that you do. This includes being intentional in the questions that you ask and using the moments of downtime to get to know patients. Once you have found yourself being more efficient with daily paperwork and details of each day, you will find more downtime. What you do with this downtime is critical to being efficient and intentional. This is the time to use to "touch base" with patients with whom you didn't get to spend enough time during rounds, or with those who present a particularly difficult case. This time can also be used to dictate information on discharged patients, prepare notes for the next day, update discharge paperwork, and even to study. Frequently, people will say they have no time to study or read outside of work, but it is all about being intentional.

Work as a Team

Work as a team that is made up of many parts. This can sometimes be the most challenging for many reasons, the hardest of which is that no two people are the same in the way they do something. Interns frequently feel that they have little say in how things are done, but nonetheless they are part of the team. Even as a senior resident on the cusp of finishing residency, you are under an attending doctor who may do things the exact opposite of how you would do them.

The first part of the team concept has to start with the intern and the resident learning how to best work together. Learn to trust one another, based on experience and competence. The second part is to work with the attending on how to manage the patient, with some back-and-forth dialogue, knowing that the attending of record is ultimately responsible for the patient and has the final say. Accept it. Move on. Finally, there are nurses, social workers, case managers, consultants, nutritionists, and others who are all part of the team that takes care of any one individual.

Learn to communicate with the team effectively and frequently. Communication is key within a team. Come up with a plan as a team on how to round, whether it means starting on the top floor and working your way down or some other variation.

In the end, making an in-patient service run smoothly is about being effective and efficient as a team, but it is much more enjoyable when it can be done in such a way as to be enjoyable. Learn to enjoy the experiences of residency, and realize that your peers are going through the same experience. Learn to have fun in the midst of fatigue; it goes a long way when everything does not run as smoothly as planned.