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AUTHORS:
Neeraj Kohli, MD, MBA
Director, Division of Urogynecology, Brigham and Women’s Hospital, and Assistant Professor, Department of Ob/Gyn, Harvard Medical School, Boston, MA
As a urogynecologist, I often perform as many as eight or nine operations a day, and most of them are very similar and hopefully uncomplicated procedures. I have often been frustrated with the mundane documentation required of physicians, and nowhere is that more prevalent than in our dictation of routine and uncomplicated surgical procedures. Long ago, I realized a better way to accomplish the same task that is a win-win for all parties involved. I have created a series of templates for various urogynecologic procedures and portions thereof. These templates are then e-mailed to the dictation service at the hospital for later use. After I have completed my surgery, I call into the dictation service and begin normal dictation of the particulars of the case, including patient name, account number, preoperative/postoperative diagnosis, procedure, anesthesia type, blood loss, pathology specimens, and indications for surgery. Once I get to the details of the operation, I simply dictate “please use Dr. Kohli's operative templates” and then proceed to dictate "insert prep and positioning"....."insert transvaginal suburethral sling"....."insert postprocedure". I then finish my dictation.
The win-win comes immediately, as I can do each dictation in a fraction of the time that I used to spend on a complete dictation for each procedure. One of my colleagues once belittled my process as I “was only saving maybe 10 minutes by doing it that way"; however, 10 minutes multipled by eight cases in a day means that I get home 80 minutes earlier, enabling me to spend more time with my family! In addition, the dictation service saves much more time and frustration by not having to decipher my rapid and often slurred speech patterns. Rather, they just cut and paste the appropriate template. Finally, I save time on the back end by not having to review each dictation in detail but rather just having to confirm that the appropriate templates were used.
It is important to remember that specific details of the procedure and complications or unusual findings need to be dictated separately, but this can be done within or between the templates. For instance, this would be an ideal situation for a routine Cesarean section template where the final lines of the dictation may be, "A live born baby boy Apgars [score of] 8 and 9 was delivered and taken to the normal newborn nursery within 10 minutes of delivery." Since we all evolve our technique over time, any material changes in your technique should be coordinated with changes in your template. It is important that your template reflect your procedure; for example, my hysterectomy template says that I identified the ureters on both sides and I do so on a routine basis. Use of templates can require more attention to detail, but can also save you significant time and work when used correctly. I know my family appreciates this on my long operative days and I hope yours will too!