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Mabel

We use the "T" system and I find it to be lacking in certain pediatric areas. For those who are not familiar with these: a set of ready to complete checklist/write in sheets based on presenting symptom. There are the general illness, injuries, cough, V/D, etc. Yet, there is no sheet for sickle cell disease or chest pain. The list of discharge diagnosis is not always complete. For instance the "Upper Extremity Injury Template" does not list radial head subluxation as a possible diagnosis,  the "Wheezing Template" does not offer fever as a diagnosis, and the "Facial/Head Injury" offers contusion/hematoma/concussion but not just plain old head trauma. These sheets do not have an area to list an age or the vitals signs - things that we commonly write in on the sheet. Some of the areas that you are supposed to write in for either the hx or progress in the ED are very limited. The hx area for head trauma allows you to write maybe a sentence. It is difficult to document if meds were given or the course of ORT or asthma tx. There is a very small area for the attending progress note so most of us (attendings/PNP) use the template and the residents write progress notes. Also, there is no area to document discharge instructions or medications. Some nice aspects of them are the laceration repair procedure note, LP procedure, and documentation area that the PMD was notified. They can be quick but sometimes finding the right word to backslash or circle is not. I find that the concept is a good one but I think that the flow of the hx can be awkward and there needs to be improved documentation areas. (I think that I tend to lean heavily on the problem with documentation b/c there are so many times that I am called by a PMD wanting to know what happened in the ED and I pick up the T sheet and I am not seeing a lot on it.)