Twenty years too late?

I recently paused to think about what I was doing (which is always fatal) and realised I was drowning in paper.

I was looking after seven in-patients, all in various stages of recovery. Each patient had a set of computer records where the narrative of their stay and invoicing were kept, while the hour-by-hour notes were kept on two sheets of paper – a “monitoring” sheet where temperature, pulse, respiration, hydration status, and so on were recorded, and another sheet where their medications were recorded (drug, dose, time, route, etc).

They would often then have separate sheets each for biochemistry, blood count, and blood gas, urine samples. ECGs were bundled in there, as well as the anaesthetic record sheets if they’d had surgery. If they were a critical care case or needed artificial feeding there was a sheet for that too.

One cat had been with us for a week and in that time had generated a pile of notes about half an inch thick. If you wanted to know what happened on the Thursday you’d have quite a search – and that’s if they were kept in a logical order.

One practice I worked at got this right (sort of). They had a “no paper” rule – all paper records generated by a patient were scanned into the patient’s records on discharge, and the physical paperwork shredded. This at least got over the duplication of effort; writing a comment on the paper records meant it was permanently recorded on the patient’s records in some form.

The practice had invested in a proper sturdy fast automated scanner, and had taken the time to set up their practice management software to automate it and make the process as quick and efficient for the staff as possible. The easier something is, the more likely your staff is actually to do it.

I have yet to work somewhere that makes use of computerised forms that imprint onto the records as you type it into a form (so it’s there in black and white on the records as soon as you hit “save”).

The proliferation of tablets these days should make this a “bedside” task as well, further cutting trips from kennel to computer and back again.

This may sound like a luxury, but in the event of something like a complaint, having everything to hand – and, importantly, everything to email to management or the Veterinary Defence Society (VDS) – is well worthwhile.

There is no accurate way to quantify the time saved, but I’ll bet it’s hours per week saved writing up and ultimately duplicating notes.

There is also a change in the “feel” of a place when there aren’t piles of paper and notes dotted around the place.

Are there any other practices out there who can claim to be closer to the “paper free” ideal of 20 or 30 years ago?