One Word: Mnemonics.
Spoiler alert: charting takes forever.
If you are a student, the fact that charting can take over your life might be a surprise. If you have been in practice for more than one week, this is old news. Like, really old. Everyone knows it, everyone hates it, and solutions are in short supply.
Students know that mnemonics are efficient ways to wrap their heads around complex concepts or chunks of information that need to be committed to memory fast. And once those mnemonics take root, they usually stick (I still think “CSMT – color, sensation, motion, temperature” every time I evaluate circulation).
The illusion that once we enter practice everything is just going to fall into place and be perfect – that’s a fallacy. So why in the world would we give up a shortcut? Do you really want to spend MORE time charting? No, you don’t.
Focused Visit → Focused Note → Faster Charting
One of my favorite mnemonics is OLDCARTS: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing, and Severity.
You can use this mnemonic to guide the conversation for an overwhelming majority of visits. Follow the mnemonic, and it will help to manage the flow of the visit. And staying on track in the visit will help you to stay on track in your note – which will get it done faster and get you the hell out of the clinic sooner.
Here’s what it might look like with a patient with knee pain:
Put it together in a quick HPI narrative:
“John Doe presents with concern for right knee pain [LOCATION] that started two or three days ago [ONSET]. No known injury. He reports a brief sharp pain with some movements which quickly subsides to a dull ache [DURATION, CHARACTERISTICS]. It is worsened by going up stairs, squatting, or applying pressure [AGGRAVATING]; it is relieved by rest, elevation, and use of ibuprofen [RELIEVING]. He endorses achiness that is constant [TIMING] (rated a 2-3/10) [SEVERITY], with occasional sharp pain (5/10) [SEVERITY].”
Throw a quick assessment and plan in there (most of which will come from clicking off pertinent positives/negatives), and you’re DONE.
You don’t need to reinvent the wheel each time you chart, and especially not each time that you are charting on the same presenting concern, like knee pain. Consider using your favorite mnenomics to build a few note templates in your charting system. There are no awards for creativity or originality in charting (though maybe there should be?).
You might hear about it if your notes don’t include what they should, but otherwise, I’ll tell you the truth – no one really cares how GOOD your notes are. As long as your bases are covered so that the next person who needs to read or refer to this note has what they need to take care of the patient, and as long as the payer has what they need to justify paying for this visit, you are fine. Mnemonics will do that.
Mnemonics are a great way for new grads to make sure they are crossing all of their T’s and dotting all of their I’s. They’re a great way for providers drowning under a pile of open charts to come up for air.
Harness the power of mnemonics to speed up your charting.
P.S. If you don’t already have a list of mnemonics that you like, you can check out my “World’s Biggest Mnemonics List” here.