Fourth Year - Rotation 2 - Time Management STARES

Situation
In this last week in outpatients, I set my own personal goal of being able to complete initial assessments and follow up assessments in the same time as what the other physios in the department were working at. As a student, I am given 1 hour and 20 minutes for initial assessments and 40 minutes for follow up patients. This is double the time given to new graduates and by the end of this placement I would like to consider myself up to new graduate standard in musculoskeletal outpatients.

Task
Keep an eye on the time during treatment sessions keeping in mind that I have to include a subjective, objective - a baseline for treatment, choose an appropriate treatment, reassess the outcome baseline – evaluate the treatment and also write up patients notes.

Action
Before I gathered my patient from the waiting room, I would have a quick check over the patient’s notes to review previous treatment sessions and organise in my head what we did last time, if the treatment had been working, if I had planned to try another treatment or reassess anything this time. I would also try to prepare any information sheets/exercise sheets/hydro assessment sheets/equipment I might have needed during the session. This included goniometers, tape measures, checking if there was a treatment cubicle free and occasionally checking if the traction machine was available or would be available soon. I also invested in a fob watch to keep track of the time during my treatment sessions.
Since I had the whole 40 mins for follow ups, I tried to fit my treatments into 30 mins to give me time to write up notes and prepare for the next patient as well as to give me a bit of ‘give’ in case treatments didn’t go as planned or patients turned up late.

Result
I was unable to fulfil this goal, as I tended to take around 30 minutes for each follow up patient and 1 hour for each new patient. I found that there is only so much you can plan ahead before actually seeing a patient. Patients tend to arrive and present differently from what you were expecting, not react to the treatment as you had planned or even develop further pains that you need to address or investigate further. I also occasionally had the problem of patients arriving late or the equipment not being available when I needed it. An example of this was when there was a 3 patient wait to use the lumbar traction so I had to perform the subjective and objective assessment on the patient and make them wait in the waiting room until the machine became available. I also had to shorten their treatment time as I knew other physios were waiting to use the machine after me as well. With patients who presented with multiple pains, I found I had to treat what I could and set them up for another follow up session to assess their new pains.
Not all of my time management was bad though. There was this one situation when a patient arrived a day early but because of my good time management that day I was able to spend adequate amounts of time with her instead of just sending her away. I also found that during this week I didn’t end up staying back late to finish up writing patients notes as I was completing them during the day instead. This was a huge change from previous weeks where once I stayed back an extra hour to finish paperwork! I still found that patients with English as their second language harder to fit into my time restrictions.


Evaluation
When I started giving myself 30 mins for each follow up patient I found that I was able to keep in this time limit. I found this new ‘time restriction’ great for keeping up with notes so I was not spending an hour at the end of the day just catching up on paper work. I still feel though that I still could have been more efficient with my timing as I never quite made the 20 mins follow up times as I would have liked. On the other hand this is not really expected of a student, but at the end of the placement I thought I should have been as fast as a new graduate.
Even though I did not achieve my time limit goal, I took pride in the fact that at least I knew didn’t rush my treatment sessions and I hardly ever went over time with patients. I found this time limit was a good learning curve for myself as I like talking/building rapport with patients but in an environment such as outpatients, this is not as easy as when working on the ward. I also found my questioning for subjectives becoming more precise as well as choosing just the necessary assessments for the objectives and the objective outcome measures.

Strategies
You don’t need to ask EVERY SINGLE QUESTION on the assessment form.
You can gather information in different sessions not just in the initial assessment.
Sometimes you have to interrupt a patient if they are quite talkative and refocus on the question at hand
Having a fob watch is a great way to keep track of the time!
You can’t treat every thing in one session – patients are usually happy if you just do something about their pain!
If a patient is late you need to take that into consideration with their treatment or hopefully have stocked up enough spare time from other treatments
There are always other physios at hand if you need help!