1. Team Documentation Lindsey B. Dolohanty, MD
Assistant Professor of Dermatology, University of Rochester School of Medicine and Dentistry

2. Why team documentation
Young attending
Spent 4 hours after full day clinic “just catching up” from that day
Unable to use scribes (2014)

3. What/who is it: Attending 2 LPNs 1 clinical technician +/- resident
**Formal job descriptions for each

4. Where/When important:
Outpatient clinics
High throughput specialties
Dermatology
Potential for multiple unexpected small procedures/wound care

5. How: Templated note 200+ smart phrases created by attending physician
Teamwork
Approved by compliance
Direct observation
Notes reviewed
URMC approved attestation of notes

6. Importance: Avoid attending physician burnout
Reduce physician work “after hours”
Increase efficiency/avoid delay in clinic
See additional patients

7. Goals of TD: Maximize use of all team members
Engage all team members in patient care and thus ability to include them in personalized after care
Greater job satisfaction for all
Attending takes full responsibility for everyone on team
Maximize face to face time (attending-Dr)

8. Limitations of TD LPNs have limited specialty knowledge
Patients/situations arise that don’t fit a template
An experienced resident + attending is faster than TD LPN + attending in difficult situations
Residents are in clinic to learn as much as they are to “work”

9. Limitations of scribe Can’t touch patient
Procedures
Bandaging/wound care
“Stranger” in polo shirt can be intrusive to patient in gown wanting full body skin exam
Outpatient rooms small for “extra personnel”
Can’t obtain patient consent/numb patient
Patient might not share all of their history for a given problem with scribe in the room