Example Endoscopy Orders
When placing an endoscopy order, it is useful to imagine yourself in the place of the case manager or endoscopist who is reviewing the order for approval. You have no idea who the patient is, what their history is, etc. Without a brief synopsis and pointer to the applicable encounter[s], mining the chart notes to piece together the case can be very frustrating and time consuming. A few short phrases can turn a 15-minute order review into a 30-second order review.
Examples of efficient and effective endoscopy orders (i.e. in the comments tab of the order):
(1) 65yo asymptomatic male, no FamHx CRC, no prior CRC screening; has CHF but meets low risk criteria (see 1-10-2017 cardiology note in multimedia manager).
(2) 55yo female, recommended surveillance of polyp from 6-4-2012 colonoscopy at ANMC, no FamHx CRC.
(3) 49yo male, +FamHx CRC, normal colonoscopy 6-1-2007 and 9-5-2012, due for q5y screening.
(4) EGD+colonoscopy for 45yo male with large Hbg drop and 30lbs wt. loss over last 6 mos. See 7-5-2017 clinic note.
(5) EGD for 56yo male with 2 years of progressive dyspepsia refractory to PPI, with worsening anemia. No prior EGD's. See 7-5-2017 clinic note. Anesthesia consult for BMI=43 and asthma.
(6) EGD for 45yo male with Hx of EGD 2/2012 and 5/2014 for nonulcer dyspepsia but now with new tarry stools and 40lbs wt loss since 6-10-2016. See 4-5-2017 clinic note. Prior EGD's done in Seattle and we do not have records.
Most of this information is probably in the thoughts of the orderer, but can be difficult and time consuming to reconstruct by a reviewer who is unfamiliar with the patient. A 5-15 word synopsis and, when applicable, a pointer to the pertinent chart note[s], greatly expedites review and approval.
In addition to efficiency, informative orders are more likely to yield a quickly scheduled procedure because they can be immediately approved and scheduled by the case manager rather than moving into the queue for MD Review (which sits untouched until an endoscopist has AD time in the Surgery department).
Additional thoughts:
- Use pointers often! You cannot overuse them. In order #2 above, the phrase "from 6-4-2012 colonoscopy at ANMC" not only gives a date, but also points at where to look for the OpNote and pathology report. This allows the surgery department to leverage the time that the orderer has already invested. Also use null pointers when applicable; in order #6 above, the statement "Prior EGD's done in Seattle and we do not have records" prevents the Surgery department from wasting time looking for records which we do not have.
- If these order comments start seeming burdensome, then remind yourself that specialist referrals customarily involve a dictated case summary. With this in mind, you'll likely appreciate the brevity of these order comments.
