25X5 Symposium: Fighting Clinician Burnout

The 25X5 Symposium brought leaders in the community together find strategies to reduce clinician documentation burden to 25% by 2025. As an avid champion for clinician wellness, Dr. Subha Airan-Javia joined the symposium to demonstrate how better technology can reduce the burden on clinicians.

More Than a Burden: A Wiki-Based Tool to Make Documentation Count

 

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CareAlign FAQs

If you still have questions or suggestions for CareAlign, please reach out to us at help@CareAlign.ai

Why don’t I see the patient I just added on my list?

The patient you just created may not have been added to your list. Click on the “add patient” button at the top of the page & search for your patient using their first name, last name, &/or MRN. Click the “Visit Started” link to bring up the visit details. Once there, search for your list to add the patient as a primary or consult patient. See “How do I add a patient to a service” to see more detail.

How do I add a patient to a service?
    1. When first creating a patient, when you get to the “admit patient” window, in the bottom right section, search for your list where it says “Search Service.” Once you find your service, select it. Once you select it, your list will be added as the primary list (if there is no other list selected) or the consult list (if there is an existing primary list). You can switch a list between primary and consult using the radio buttons.
    2. If you are on a patient’s page already, click the area of the header just below the code status. It will bring up the same window as above, and you can follow the same process as in step 1.
    3. To remove a patient from your list, click the trash can next to your list name from the Admit Patient/Edit Visit pop up.
    How do I take a patient OFF my list?

    From the patient’s page, click on the middle of the header just below the code status. This will bring up the “Edit visit” window. Click the trash can next to your list name from the Edit Visit pop up.

    To remove a patient from your list, choose the trash icon.

    How do I keep a list of discharged patients?
    1. Create a new list, and name it whatever you want (ex: “Medicine 1A - Discharged”)
    2. Then, when you are discharging a patient, click on code status in the header on the patient page
    3. In the “Edit Visit” window, remove your current service (click the trash icon next to it) and add the NEW service you just created.
    Where do I find the list of available dot phrases and keyboard shortcuts?

    On desktop, click on the “Shortcuts” link, within the app to bring up the keyboard shortcuts and text expansions. The text expansions are also listed on the FAQ page, here.

    How do I request a new dot phrase?

    Easy! Just let us know what you want by using the feedback form to request a new dot phrase, or email us at help@carealign.ai.

    I want to create a new bundle for my team - how do I do that?
    1. Click on “Bundle” either from the home page or from within a problem.

    2. Once on the bundle screen, click “New”, this will allow you to create a new bundle.

    3. Add the items you want to include in your bundle (you can add A/P items or tasks). In this screen you can add highlights, flags to different items that you want to have added every time with the bundle. To make the bundle viewable by others, choose “viewable by others” before saving your bundle.

    Note: If you would like to make “official bundles” that are visible to everyone but only editable by certain people, please request “official bundle access” by emailing help@carealign.ai. This is useful for making a standard bundle for a unit or service that you want to make sure other people do not edit.

    I want to edit an existing bundle, but I’m not able to?

    If you are unable to edit a bundle, check if the bundle is marked as “official”. Only users with “official bundle” permissions are able to edit all bundles. If you have additional questions, please reach out to help@carealign.ai

    How do I add a bundle to my problem?
    1. From within a problem in the patient’s careplan/wiki click the “Bundle” button
    2. Search for the bundle you are looking for.
    3. Click on the bundle you want.
    4. This will show you all the potential bundle items to add to your problem.
    5. You can UNselect certain items so they don’t get added to your problem.
    6. Once you are done, click “Apply to Problem.”
    What is the best way to do a systems based plan?

    Users can create a system based plan in two different ways, using a bundle or using separate problems.

    See it in action here: https://www.youtube.com/watch?v=vezOAJ3ILDs

    Using a bundle (the faster and more condensed way):

    1. On the patient wiki, create a problem where you will put the systems based plan. You can call it ICU Care, for example.
    2. Within the problem, click the “+Bundle” button, search for systems based bundles by searching for the word “system.”
    3. Once you find the one you want, click on it and choose “add to problem.”
      ** Note if there are elements you do not want to add, simply uncheck them before you add the bundle to your problem.**
    4. This will create an A/P item for each system. Fill out your plan for each system. Keep in mind, you can flag any A/P as an FYI so that item shows up in every view for every user.

    Using problems (for a more detailed plan):

      1. On the patient wiki, create a separate problem/issue for each system.

    Regardless of how you build your plan, both can be easily pulled into your note using the “Actions” button. Additionally, you can take a snapshot of the patient’s care plan at any time by using the “Save & Sign” functionality.

    How do I do a simple sign out all from one view?

    By using the “Day View” you can add/update the one-liner and the data box as well as view/create/update FYIs and tasks. This allows you to manage your simple sign out on a single page.

    See the full process in action here: https://youtu.be/nWpmqAYJ8ds

     

    What comes into a note?

    By default, the one-liner, the subjective information box and active problems are brought into the note. You can choose to bring in the pending tasks.

    Where should I put a patient’s past medical history?

    You have several options for where to put PMH:

    1. You can put relevant PMH in the one liner: 74y/o F with h/o DM, HTN, CAD….
    2. In the “Data and other info” section (the 2nd box under the one liner box), you can keep information here that will not come into your progress note. This box is visible on all the list views as well. You can keep a section for the PMH here.
      1. There is a dot phrase you can use called “.HPI” for new admissions which can be helpful.
    3. For PMH/Chronic problems that you are actively managing (i.e. you want them to come into your progress note), you can create an “Active Issue” called “Chronic Problems being managed during this admission” and create an A/P item for each problem with a short plan.

    4. You can also create a separate problem for each chronic problem.  For more involved issues that you are managing in house (DM, HTN etc) we suggest keeping them as active issues.  For less active but good to know issues (h/o prostate ca etc) you can keep these as chronic problems.

    Where do I put FEN and PPx, L/D/A?

    There are a couple of options depending on what you prefer:

    1. You can make an acute problem named "Global" to report this information and have it print in the progress note. You can then make individual A/P items for FEN, PPx, etc.
    2. For surgical services, you can make information items within the main surgical problem for each of the following: diet, ppx, anticoagulation, etc.
    3. You can also make a problem called “Access/Lines/Tubes” to keep a list of all of these items for the patient and track any tasks that you may need to perform for them.

    How do I discharge a patient?
    1. Click on or around your patient’s visit information in the header bar to access the edit visit modal. Here you will see an option to  ‘End Visit’.
    2. When you select this, it will default the discharge date to today, though you can update that as appropriate.
    3. Once you have updated the discharge fields, you may click ‘End Visit’ to complete the process.
    4. This will take you back to the same visit’s page, and the wiki will still be there for you to work with. There will be an identifier under the patient’s visit information that reads ‘*Not in House’ to differentiate between patients with active visits and those with non-active visits.
    5. Now, you can move this patient’s visit to a discharge list, a follow up list, or remove this visit all together. You can do this by opening the edit visit modal again, where you can add or remove the patient's visit to different lists.
    6. Note - you will now see the visit end date, which is not editable, So please make sure you do not end the visit, until the patient has actually ended their visit.
    7. When you go back to the landing page, any patient visits that are not active, or have been discharged from the hospital, will be grouped at the bottom of the list in alphabetical order. Their location will now display as ‘No Active Visit’.
            How do I copy forward a patient's visit?
            1. You can start a new active visit for your patient a few different ways. 
            2. The first way is to click on any patient on your list who has ‘No Active Visit’ listed to the right of their name. 
            3. You will be directed to the patient wiki. Click on or around your patient’s visit information in the header bar to access the edit visit modal.
            4. Once a patient has been discharged the ‘Start New Visit’ button will be listed on the Edit Visit modal. By clicking on this button, you can add your patient to the same list or a new list, just as you normally would.
            5. The second way you can start a new active visit for your patient is by searching for your patient using the ‘+Add Patient’ button.
            6. To start a new visit for your patient again, click ‘Start Visit’ and create a new visit just as you would normally do. CareAlign will automatically bring forward your patient’s information such as name, MRN, DOB, Gender, Emergency Contact Information, and Allergies 
            7. Now to copy forward, click the “actions” button, on the patient page, and choose ‘Copy Forward from Previous Handoff.’
            8. Here are the things that WILL copy forward:
              1. Problem names
              2. Unchecked tasks (if you select this box)
              3. Info items within each problem, which will all become “historical” so you can quickly reference what happened last time.  If some of the information is still relevant to this admission, yu can simply click on the “a/p” icon and change the item from “historical” to “Current plan”
            9. What will NOT copy forward, is the one liner, data or subjective boxes. We found that often those fields were not updated after copying forward, and that could lead to potential errors. So, for now you will need to write them from scratch. 
            10. Once you click the copy forward option, you will see a list of the patient’s prior visits with the start and end dates, as well as which primary team they were on for that visit.
            11. If you are not sure which visit you want to copy forward, you can click on the different visits to see what was on the care plan, and choose the one you want to copy forward.
            12. Once you have the one you want, simply click “copy” and that’s it!
            13. You will now see the problems in your plan. If you click the “View History” button under a problem, you will see the prior visit’s information and a tag with when the information was copied forward and by whom. Anything marked as ‘Historical’ can be easily moved back to the current plan. You can do this by clicking on the Historical Icon and selecting ‘a/p Current Plan.’
                  How do I update information about my list?
                  1. Click on ‘List’ from the home page.
                  2. Click on ‘Create new list’ button to create a new service.
                  3. Create a new name for your service and add the team information for that service. We suggest creating lists at the level of the intern, so each intern can see their own list of patients.
                  4. Then the supervising resident or the attending on that service, can save all the lists for their team together, to see a consolidated list of all the patients they are following.
                  5. All of this information will be editable, so if you need to update the service name or add new members to your team, you can do that at any point. 
                  6. All members of your team can search for this newly created service and add the service to their own landing pages. That way, all members of your team will have the most up to date news on your patients throughout their whole shift.
                  How do I flag a task?

                  You can create a standardized way to flag tasks. Dr. Subha Airan-Javia recommends flagging night tasks as blue and day tasks as yellow. 

                  How do I mark a patient as sick?

                  If you’re worried about your patient, you can mark them as sick, so the entire team is aware of their status. This will change their name to red both on the patient wiki and in your list view.

                  How do I move tasks to be listed under other problems on on my care plan?

                  You can easily move tasks on your care plan to different problems at any time by clicking on the icon next to the task and click “more”. The Edit Task modal will pop up and you can select the new problem you would like your task to be listed under. 

                  How do I use colored flags to categorize the patients on my list?

                  You can use the colored flags to categorize your patients. For example - your patients that require a follow up could be flagged as yellow. For an inpatient setting, Dr. Airan-Javia suggests flagging patients that are ready for discharge as green.

                  How can my team plan for discharge?

                  Any item can be flagged as being related to discharge. This helps you plan as a team for discharge.

                  Any task related to discharge will be grouped under the 'Discharge Plan' section on the patient wiki. 

                  How do I create a new list?
                  1. On the home page, you will see the 'List' button, located in the top left corner of the screen.
                  2. Simply click this button to get started. You can search for existing lists here or create new ones for your team. 
                  3. When creating a new list, we suggest creating lists at the level of the INTERN so each intern can see their own list of patients. Then the supervising resident or the attending on that service, can save all the lists for their team together, to see a consolidated list of all the patients they are following.
                  4. CareAlign enables you to add details to your list, such as providing the team names and phone numbers. That way information is always readily available when you need it most. Creating patient lists reduces errors in handoffs, efficiently manages patient care, and celebrates collaboration.
                    How do I create a new patient visit?

                    You can easily start a new visit for any of your patients. Simply click the 'Add Patient' button and search for your patient by first and last name, and/or MRN #. If you do not see your patient listed, select the option to 'Create New.' From here you can easily update the details about your patient and their visit, including age, emergency contact information, location, and allergies. Once you have entered all of the necessary information, add that patient to your list and begin your visit!   

                    How do I add tasks from the list views?

                    You can easily update your one liner, data boxes, add new anticipatory guidance items, or add new tasks from the list views. All changes to your patient in the list views will also be reflected on the care plan. 

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