1. Use a clipboard or notebook or stack of index cards to organize your patient information. You need to have a complete, up-to-date list of patients including their ward, room number, hospital identification number, etc.
2. Make a written, or verbal agenda before starting. Plan the morning's activities in advance. Check off tasks as they are completed. Review list with supervisor at beginning and/or end of day.
3. Prioritize. See the sickest patient first. Ordinarily, this means starting in the ICU. Try to finish with one patient before starting with the next. Make rounds at one nursing station at a time.
4. Review the chart thoroughly. Check each section of the chart for new entries (orders, flowcharts, progress notes, consults, test results, etc.).
5. Assess your patient. Greet the patient. Solicit the patient's agenda with an open-ended question, "How are you today?" Ask questions to follow up known problems. Do a limited physical exam focused on patient's complaints and known problems. Explain your impressions and plans to the patient. Do patient education. Ask the patient if he/she has any questions.
6. Write progress notes. Use S-O-A-P format. Be concise, but thorough. Avoid ambiguous short-cuts, i.e., "Afeb VSS." Update problem list daily. Specify plans specifically.
7. Write orders. Use your problem list/plan as a guide. Will you need any lab/x-rays tomorrow a.m.? Look for reminders on front of chart. Obtain a cosignature from your attending or resident.
8. Plan remainder of day. Review x-rays, EKGs, etc., with team and experts. Talk to consultants. Perform procedures. Keep patients/families informed. New admissions!!! Update progress notes, if necessary, at end of day (especially ICU patients).
9. Plan for tomorrow. If possible, do discharge summaries/orders in advance. Get consent for procedures/tests.
10. Keep moving!!
