How to prioritize a full day and other stories

9 hours today, and it was JAM packed. So much so that it will span into tomorrow morning.
Mondays are always difficult for me since every name and face is fresh. To top it off, we were shorthanded today which adds the task of prioritization into the mix. There are many methods for this, some of which are mutually exclusive, and some of which aren't applicable when you need them to bed. Regardless of what I choose, it is hard to pick and know that a certain amount will not get done.
Here are a few of the ways that you can prioritize evals-

- Pathway patients first- this is an overriding rule in my facility. Gastric bypass, new stroke, spinal surgery, and joint replacement patients are on a "pathway" and need to be seen on day 1.
- Highest priority first- this is common sense, but we have a box on the referral form to indicate whether the pt is supposed to discharge in 24 hours. These pts become top priority, however, these forms are not always marked to facilitate this. You can meet with the medical team though, and ask them who is the biggest priority (and also ask which referral was inappropriate and can wait another day). I have been told that I can say, "I can only see X# of your pts today, who should it be?" if there is no distinguishing factor between them.
- Oldest orders first- this is what I did today since it's the first day after the weekend. We try to see everyone within a certain # of hours of the referral being written, so I just started with oldest orders.
- Divide and conquer- when we are swamped as a department, sometimes I find it best to meet with the PT in my area and split our mutual list. This way ALL the pts are seen today by at least 1 discipline and have a discharge recommendation.
- Least likely to leave last- as a corollary to highest priority first, the patients who are sickest and least likely to be discharging soon can usually wait a day. So pts in the intensive care units are lower priority for evaluation unless the need is for splinting.
- Most complicated first- sometimes it makes the day better if the most difficult pt is tackled first. Plus if this pt requires a time-consuming eval or intervention such as splinting, at least it's done and out of the way.

Does that cover it? I don't know. There will still be days when there are so many evaluations in the box that your eyes begin to spin and glaze over. I had a few weeks like that on the medical floor where I went through each day in battle mode- just taking the 6 evals I could handle and throwing my hands up at the rest. The other thing that these models don't take into effect is the need to do follow-ups. I don't know how to get a good balance there, and need to figure it out pronto since people stick around longer on the neuro floor, and I will be there in .. a week? Any tips on managing the mix of evals/followups?

So after sorting today, I started off at 930ish with pt #1 who had a gastric bypass. #2 was an older lady who was a turnaround discharge/admission, both times with pneumonia. #3 got derailed since he was meeting with his boss. #4 was in the ICU but also got derailed since he was moving to the floor that second. #5 was supposed to be a quick re-eval of a lady that I didn't even pick up pre-op, but she is doing much worse now and required over an hour. She had to have the wound care nurse come see her before our treatment could continue, so I grabbed a sandwich in that time and also went to see a little newborn w/ cleft palate. #6 was an ICU followup that didn't work out very well but was done at request of a PT I was working with. Then I hopped back upstairs to see pt #4 which went ok, and finished the day with pt #3 which was fair. In the midst of this, I also had to do another 2 chart reviews that didn't turn into actual billable events. Wound up with great productivity but will still be typing up #5 and #6 tomorrow morning. That will probably be a slow starting day since it is my turn in rounds and we have our weekly team meeting right after.

(By the way, I'm not trying to be patronizing about my patients by numbering them, but it's hard work to come up with aliases for everyone, and I don't anticipate touching on any of these stories again.)

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