How to keep track of patients and tasks

You've probably heard from senior residents and attendings that you need to develop your own system to keep track of your patients and daily tasks. Not only is it important for you to know basic information, such as your patient's name, age, gender, past medical history, reason for admission, hospital course, labs and imaging, but you must also keep track of your day-to-day tasks and to do's for that day.

What do I mean by day-to-day tasks?

There are certain items you will find yourself doing daily for every single patient. On a general medicine inpatient service, every morning I am checking and completing the following:

  1. Morning labs

  2. Daily progress note

  3. Order tomorrow's labs

  4. Update handoff

For residents on a surgical service, this may look more like:

  1. See and evaluate the patient

  2. Consent(s)

  3. Preoperative labs

  4. Postoperative check

  5. Handoff

What do I mean by to do's for that day?

This list can comprise of anything other than the 4 daily tasks noted above. Examples include, consulting a specialty service, ordering new medications, calling the patient's PCP, updating family members, etc. For patient's being discharged that day, I'll often write down discharge instructions, discharge summary, and medication reconciliation for my to do's.

How do I keep track of everything?

I've created a system, in which I will create a box next to every item that must be completed. When I've started a task, I will create a vertical line through the box. If the task is fully complete, I will color the box in.

Every morning, I will sign into the computer and print out a list of the patients I am taking care of that day. I am fortunate that my hospital's computer system allows me to customize the information I want on my printed patient list. I include: patient name/age/gender/room, patient summary, recent vitals, new labs and imaging. After printing this out, I will create 4 boxes on the left hand side to correspond to the 4 daily tasks: AM labs, progress note, tomorrow's labs, and update handoff.

I will then fold the right part of my list to write down my to do's for that day and use the same box system to keep track of my progress throughout the day.

What does this look like in reality?

Below is an example of what a printed patient list may look like. After printing out the list, I will create 4 boxes next to every patient and add any additional information on my list that is pertinent, but didn't print out. Here, I have reviewed AM labs and started my progress note. I have not begun ordering tomorrow's labs or updated the handoff.

This is what my list looks like when it is folded. By not folding the list completely in half, I am able to quickly visualize which patient I am referring to in every column. The tasks I write on this folded section are my to do's for that day. Here, I have placed the consult cardiology order but have not called or talked to them about the patient. Once I have talked to the cardiology team about my patient, I will color in the box. I have also ordered ceftriaxone for the patient and confirmed on the EMR that the antibiotic has been given to the patient.

Getting into the details

Below is how I keep track of my daily tasks and what my system means to me. However, you may already have your own system that works for you! I am sharing this information in case any one needs help because this has helped me tremendously this past year as an intern.

1st box: AM labs for that day

Box with slash = morning labs from that day have been collected but haven't resulted or not fully back

Colored box = all labs resulted and reviewed by me

2nd box: daily progress note

Box with slash = I've opened a new progress note and started it, but it's not complete

Colored box = I've completed, reviewed and signed my progress note

3rd box: tomorrow's labs

Box with slash = I've started to place orders for tomorrow's labs, but haven't reviewed or completed my orders

Colored box = I've signed and reviewed my orders for tomorrow morning's labs

4th box: update handoff

Box with slash = I've started updating my handoff for night team, but it's not complete

Colored box = Handoff has been updated and reviewed. To do's for night team have been reviewed.

I have been using this system this past year and it has kept me organized on very busy services. Comment down below what your system looks like. I'd love to hear about it!

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