Why Physicians Should Close Charts on Time

Last week, I discussed closing charts “on-time,” which is a different target for everyone. My healthcare-system employer states a goal of closing the patient’s chart within two hours of the appointment time. My own goal is to close it as quickly as I possibly can to avoid a mounting pile of charts that I am left to stare at glumly at the end of the day.  

Some days are better than others, although it’s both the rare day that I am walking out of the office on the heels of my last patient, all charts completed, just as it is the rare day I am still typing away two hours after the last nurse has left our clinic. Most days are somewhere in the middle.

Still, I try to close charts quickly for a whole host of reasons that go beyond getting home on time. These include:

1.) Teamwork. I am but a link in the chain on my patient’s health care journey. If I am seeing a patient in clinic for the curious “Follow up ER” visit, it is immensely helpful to actually have the ER visit note to read.  Likewise, I’m sure the ER doctor appreciates looking at a completed note when he is seeing a patient I failed to treat to the patient’s satisfaction earlier in the day.

2.) Better family life. If my notes aren’t done by the time I pull into my garage, I’m sure my family can tell the difference. Sometimes it’s obvious, like when I bring my laptop out to the backyard so I can type and watch the kids play. Sometimes it’s less so, like when I don’t fully pay attention to dinnertime conversation because I’m still cataloging the notes I have to finish.

3.) Improved Accuracy. It’s hard to remember which of the five elderly patients had the systolic heart murmur when I’ve batched all the notes together for the end of the day.

4.) Efficiency. While efficiency is usually an argument for batching notes - saving three, eight, or 25 notes to do all at the same time - I challenge you to try to close one note at a time compared with working on five notes in one chunk of time and see which option makes a better use of your time.

5.) More focus during ‘uni-tasking.’ I am a first-rate multi-tasker with all the disastrous results to show for it. If my sole job is to just finish the note for the one patient, I am able to focus better for the two or ten minutes it takes than if I am working through a (boring) pile of charts that compels  me to reallocate my attention every few minutes.

6.) Financial perks. My charting is better when I finish the notes quickly, which means by coding is more accurate, which usually means the bottom line is better.

7.) Legal advantages. I’ve served as an expert witness in a few malpractice cases. Among other lessons learned is that charts and notes may one day be meticulously examined by dozens of people who may argue about the nuanced meaning behind a single word choice. I’d much rather be explaining a note I closed within 30 minutes of the patient’s appointment than a note I closed a day, week, or even month later.

8.) Reputation. Extremely competent, intelligent and capable physicians may have towering charts on the edge of their desks (or a lengthy pile in their inboxes) while less able physicians may have each note completed right on time, but for many reasons, physicians who complete their office visit notes in a timely fashion give the appearance, at least, of being responsible, on top of things, and careful.

9.) Accurate Patient info. This is the most important. I once was trying to uncover exactly when a patient’s neurologic deficit started. I sat down with a several-inches-thick chart to figure it out. I was able to isolate it to sometime between 1998 and 2007. Some notes reported the deficit whereas many just included the standard “normal” verbage under the neurologic exam. The lesson: It’s imperative that patient information is accurate in the medical record.

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