How do things get into your workload?

There is more than one way an item can be added to your workload. Some are manual and intentional, others are automatic and computer generated.

Manual communications (human sent)

The coders communicate with you via workload messages. If a chart is blank is unassgined or a section was left incomplete, the coders will give you several days to finish it without being prompted. However, if you are delayed, they will remind you to do them by sending you a message in your workload. You must complete their request or respond to them as soon as possible. These are not computer generated, and actual person in the coding department has noticed a deficiency and is asking you to complete it. Failing to do so on your part delays getting the chart coded and prevents that person from being able to do their job.

How to keep manual communications about charts to a minimum

Keep your charts complete and signed promptly.

Automatic communications (computer generated)

Other items in your workload are generated by the computer as a fail-safe. Lab and imaging results, for example, are sent to your workload for review if you did not “see” them before the patient was taken off the tracker board. This is unusual for day to day lab work, because you will inevdibly click on those notices and review them in order to make the plan. However, cultures or other tests that do not come back during the ED visit will show up in this location. So, even if the patient is admitted, as the ordering provider you will be alerted to changes in the test status. Imaging studies, on the other hand, frequently show up here. It is not uncommon at all to discharge a patient from the ED before the radiologist has read their plain films. When they do read them, the report will come to you here. It can be a hassle, but it is important that you review them when they come to you.

How to keep automatic communications to a minimum

Click on / open the report from every lab and radiology reading. Even if the radiologist called you with a “wet read”, the official read will show in your workload if you don’t open it. Also, if you look over the resident’s shoulder and review the labs and images with them, but never open the report yourself, the computer will “assume” that you did not see it and send the report to your workload.

Often, you have written admit or discharge orders before radiology reports have come back, but the patient is still on the board waiting to be moved to their new disposition. They are on your mental back burner, but the radiology report comes back. Take that extra second and open / review those reports so that the computer knows that it has been seen.***

***The charge nurse is given a list of radiology reports to follow up on every day. Those consist mostly of x ray or CT reads that the attending never clicked on/opened. They have to spend their time trying to make sure that someone saw the images. That may include reading the MDM or radiology interpretation section of the chart in hopes that it was mentioned. Or it may mean looking at the diagnosis in hopes of proving that the fracture was noticed, for example. You can minimize that work for them but opening the radiology report.

Clearly, there are some patients that leave before the report is there, so this will never go away. But to the extent that you can, be sure to open every lab and every radiology report – even if you already know the answer.