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New grads and documentation
117 Plays1 day ago
Miranda and Josh talk about new students and documentation.
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Transcript
Introduction and Topic Overview
00:00:06
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
And I'm Miranda and we are Hand Therapy Academy.
00:00:10
josh MacDonald
We're going to chat a little bit today about how to make our documentation a little bit more efficient. There's so much time we have to spend on paperwork and recording everything we've done, progress reports, all that.
Challenges in Documentation Systems
00:00:21
josh MacDonald
how can we What are some little things we can do to make all of that more efficient?
00:00:25
Miranda Materi
Yeah, and I think some of our limitations or our abilities are within what documentation system we use. So I will say that I know people have some cumbersome documentation systems and they're not as friendly as maybe some that others have. So we'll be working off the caveat that you kind of have a friendly one.
Experience with WebPT
00:00:42
josh MacDonald
Yeah, yeah. And because we work in outpatient clinics and that we both run, we have the opportunity of having kind of whatever system we want. And we've been using WebPT for a long time. um And it is a good system. It's not a great system, but it does give us the ability to.
00:00:59
josh MacDonald
to make some shortcuts that work for us. So one of those for me, for example, is if I have a section that's range of motion and strength and neuro, I won't go through the death by check boxes, right? Like I can click on range of motion and then wrist and then extension inflection. I can click on all those. I usually go to the fill in the blank text box that says additional comments at the bottom and just type in my stuff,
00:01:25
josh MacDonald
freehand and you can double space and tab your way to a chart or you can just write it out narrative. I find that way quicker than me trying to click through boxes and then still having to enter numbers. It's just a lot fewer total steps.
Using Templates for Efficiency
00:01:40
Miranda Materi
Right. And i think too, with our system, we can build templates. So if you're seeing someone with a distal radius fracture, there's already a template there, you know, where it'll carry over some of those common goals and the common language.
00:01:50
josh MacDonald
Yeah. Yeah. Um, it, there are some things that are kind of small, silly things that just make, you know, it's a, it's a death by a million cuts when we're clicking and scrolling and and doing all this stuff. So for me, I like to start at the bottom of the page and work my way up because everything I do opens a dropdown, opens a
Balancing Documentation and Patient Engagement
00:02:10
josh MacDonald
dropdown. So I'm just scrolling and scrolling and scrolling, scrolling. But if I work at the bottom and go up, Those things drop off the bottom of the page and I can still see everything else in front of me without having to scroll any further to see it It's a small little thing. But when I'm documenting on 18 people for the day, that helps me make just that many fewer clicks and scrolls.
00:02:30
Miranda Materi
So are you documenting when with your patient in front of you or when are you doing your documentation for the day?
00:02:36
josh MacDonald
I'm fine if it's a familiar patient and it's one that's been coming for a little while so that I can type and keep that engagement with the patient while we're doing it. And it's a skill to be able to type your note and have the conversation and be divided attention. That's a skill set. But for new patients, for new evals,
00:02:54
josh MacDonald
I don't want my students, my new grads, my therapists, I don't want them going back and forth and staring at a computer screen for 60 seconds while they enter in range of motion measurements and then coming back. I feel like that totally interrupts the flow of connection with that patient. So I will scribble down chicken scratch on a piece of paper as I go that I then transfer later. And my notes transfer pretty quickly, but I'm not interrupting that connection with a brand new person that I'm trying to build rapport and earn trust with.
00:03:22
Miranda Materi
Yeah, I think for me, for the subjective part, I always, you know, just I'm there with them present in the moment. And then when we get to the objective stuff, I always just tell them, hey, we're going to be doing some measurements and I'm going to need to be entering in the data so I don't forget it.
00:03:34
Miranda Materi
And and also so it saves me time later. Like, I don't always enjoy doing documentation at home, you know, or at the end of the day.
00:03:41
josh MacDonald
Yeah. Yeah. Yeah. No, I'm with you. I, we were talking about that, about how much do you have to take home with you for documentation? Um, and I would say for all of my therapists, my goal is once you've got your feet under you and you've been in the clinic for a little bit, and we'll talk about how long that is.
Comparing Clinics to Hospitals
00:03:58
josh MacDonald
I don't want you to have to take anything home.
00:04:00
josh MacDonald
Now there's going to be exceptions where you have, uh, 4.30 eval and a 5 o'clock eval and they walk out the door at 6 and the doors have to close at 6, do you stay late?
00:04:10
josh MacDonald
Do you go home and do it? Maybe the next morning, but that is extra time.
00:04:13
Miranda Materi
Thank you.
00:04:14
josh MacDonald
But in general, I want them to not take any paperwork home once they're getting comfortable with with the process.
00:04:20
Miranda Materi
Right. Yeah, I know. That's what I try to encourage my staff to do all their notes right there. But at the same time, we don't like have gaps in our schedule where we allow for documentation. Like I know some hospital groups will have like 30 minutes of prep in the morning and then a charting time at the end of the day. In private practice, we would all be operating in the red if we did that.
00:04:40
josh MacDonald
Yes. Yeah.
00:04:41
Miranda Materi
I mean, there's there's no possible way to generate revenue and take those breaks for documentation.
00:04:46
josh MacDonald
Yeah. Yeah. No, I agree. We, we find spots in cancellations and we find spots in like these two patients are chatting, so I can do a couple notes here. um I'm curious, how long would you say the average soap note takes you?
00:05:04
Miranda Materi
Three minutes.
00:05:05
josh MacDonald
Yeah, I think that's probably where I'm at too is three minutes. And so if I set a patient off on a five minute task and they're focused and working hard, I can finish the previous patient's note. I can start building their note so I can fit those things into gaps and then still have a conversation. Maybe I'm not entirely focused on them talking about their grandma, but you know i'm I'm somewhat engaged in the conversation.
Hygiene and Patient Expectations
00:05:29
josh MacDonald
But yeah, you you should be comfortable with doing notes in about three minutes as long as you've got that friendly system that Miranda talked about.
00:05:35
Miranda Materi
Yeah, and sometimes you might see the pain, you know, you have an hour session with them or whatever it might be, and you have those five minutes at the end of the session. So sometimes, you know, if I could get them out there at the 55 mark, that gives me like three or four minutes to document and wash my hands and get ready for, you know, the next patient, depending upon, you know, what the schedule looks like.
00:05:53
Miranda Materi
but
00:05:53
josh MacDonald
Yeah. Yeah. Try to wash your hands at least twice a day, whether it needs it or not. Right. Yeah.
00:05:58
Miranda Materi
Yeah, I know. Well, i then you know I like work in a clinic where we see you know a lot of patients that are immunocompromised. And so you know we have to like run back and we have hand sanitizer everywhere. But you know you better not miss either because they're going to let you know.
00:06:13
josh MacDonald
Yes, yes. I have finished wiping my hands with hand sanitizer, sit down in front of a patient and they say, did you wash your hands? I'm like, I'm literally still covered in hand sanitizer. Yes, we're good. Yeah.
00:06:23
Miranda Materi
but good I know I have that too.
00:06:23
josh MacDonald
Yeah.
00:06:25
Miranda Materi
And, and then sometimes I'll say, well, would you feel more comfortable if I went and washed them again? you like Cause then I'm like, that's kind of a break for me anyways.
00:06:31
josh MacDonald
Yeah.
00:06:34
Miranda Materi
Like how, you know, sometimes I'll like get there and I'm like, gosh, I haven't used the restroom.
00:06:35
josh MacDonald
yeah yeah
00:06:39
Miranda Materi
I haven't drank water and I haven't ate lunch.
00:06:41
josh MacDonald
Yes. Yeah. It's three o'clock and I'm sitting down for lunch. Yeah.
Expectations for New Graduates
00:06:45
Miranda Materi
Yeah.
00:06:45
josh MacDonald
um So let's talk about getting comfortable for new grads, for maybe students learning. We were talking about that earlier. how um How much do you expect out of your new grads for documentation, pacing and efficiency?
00:07:01
Miranda Materi
I think I was just talking about this and I think I expect a lot. um Like i I want them to be looking stuff up at home. I want them to come in prepared. Like I want them really actively engaged in their patient care and and not so much from, you know, an efficiency standpoint, but because I want a therapist that cares like that. And yeah.
00:07:23
Miranda Materi
You know, or or I want them because I feel like if they're looking stuff up, they're going to be enjoying it more and they're going to be more actively involved in in their own education. And I think I I prefer that in a new grad. So I think I have an expectation they'll do it a lot. And maybe that's really not fair.
00:07:39
josh MacDonald
Yeah, yeah. And I think like we don't schedule our page our new grads at the same um efficiency rate of patients per day as our experienced therapist, right? Like we give them a chance to kind of get comfortable with the workflow and get their notes done between. they're going You're going to have to take notes home, right? It's just a given. Maybe it takes you two or three months to get to a point where you're more proficient with things, but you're going to have to take notes home most of the time.
00:08:05
josh MacDonald
That's just the reality of you're brand new at this. You aren't
Importance of Timely Documentation
00:08:08
josh MacDonald
very good at it yet. You'll get there and your efficiency will have to increase accordingly. But maybe you had a rotation and at a level two that gets your feet wet. Now we expect you to go from maybe like 70 percent efficiency up to 100 percent within maybe two or three months, um not knowing everything, just efficient with the stuff we do give you.
00:08:26
Miranda Materi
And I feel like that's when they learn too, is usually when you're like doing that recap at the end of the day or when you're doing your notes in the morning, it's kind of a time for you to process that session and ask yourself what went well, what didn't go well? Do I need to look up something for this patient for next time? You know, should I be advancing them in supination? So I feel like it's a really nice time to recap everything. And so I'm hoping that some of those new grads are going home that we hire and looking it up.
00:08:52
josh MacDonald
Yeah, yeah. Separate from efficiency during the day, what is the longest amount of time that you would reasonably accept a note being completed after the date of service?
00:09:06
Miranda Materi
not there I mean, I think I tell my therapist within two days, like I want them to be in the habit of doing it every day. But if for some reason, you know, something's gotten, you know, you whatever, you know, you missed a note or something two days, because I feel like at past that time, you're not going to remember, right?
00:09:21
Miranda Materi
How do you know how much time you spent? How do you know what exercise they did?
00:09:24
josh MacDonald
Yeah.
00:09:25
Miranda Materi
So awesome.
00:09:25
josh MacDonald
And i I feel like we've all worked with that therapist that was two to three weeks sometimes behind on notes and billing gets after him. I can't imagine there's any way that you accurately know what happened during that session when you've had multiple other sessions with them to delineate what happened two weeks ago versus one a half week
Conclusion and Call for Feedback
00:09:43
josh MacDonald
ago. I tell my therapists, I want...
00:09:47
josh MacDonald
the given data services notes done before you start a new date of service. So if that's at night, if that's in the morning before your first patient shows up, because once the new patients start rolling in, you will have forgotten stuff that that person said or that they did or update changes, their status changes. So there's gonna be outliers. I forgot to finalize the note or I just forgot to open one for that patient.
00:10:09
josh MacDonald
There's outliers, but yeah, I don't want patients, i don't want therapists going more than max 24, maybe 48 hours in an exception.
00:10:17
Miranda Materi
Yeah, there's no way that that would ever fly and create our clinics.
00:10:20
josh MacDonald
Yeah. Yeah.
00:10:21
Miranda Materi
But I have worked in hospital-based systems where, you know, I've seen where it takes months.
00:10:22
josh MacDonald
Well,
00:10:27
josh MacDonald
yeah. Yeah. And at that point, I can't imagine that that's an accurate representation representation of what happened in that session.
00:10:34
Miranda Materi
And how do you even know you have authorized it? I don't know how that would even work.
00:10:37
josh MacDonald
Yeah. Yeah. Yeah.
00:10:38
Miranda Materi
Oh.
00:10:39
josh MacDonald
Okay, so hopefully those are all tips that help you make yourself a little bit more efficient with notes. If nothing else, maybe start the dialogue about what you should expect for new grads and students and all of that. So if you have any ideas or have any questions for us, feel free to reach out to us at info at handtherapyacademy.com.