Why Your Inpatient Workflow Shouldn’t Look Like Your Outpatient Workflow

Stop trying to use one workflow everywhere. Many physicians spend years trying to find the “perfect” workflow. The problem is not that you have not found it. The problem is that you are trying to use the same workflow in completely different environments. The workflow that helps you thrive in clinic may actually slow you down on the hospital service. The goal is not to have one perfect system. The goal is to build the right system for the situation.

There is a belief that good physicians should work the same way everywhere. Many of us assume consistency equals efficiency. We create routines and try to force them into every setting. However, outpatient medicine and inpatient medicine ask us to solve very different problems in very different settings. Trying to make them identical often creates unnecessary friction and frustration. Instead, give yourself permission to work differently.

Allow me to share my own example. In the outpatient setting, the workflow is finished before moving on. I see one patient, complete the orders and documentation for that patient, then I move to the next patient. Closing the loop before seeing the next patient keeps my mental load low and manageable. I do not spend the day wondering which notes still need to be finished. That workflow works beautifully in clinic because patients come to me.

Why does that same workflow not work in the hospital? The inpatient environment is completely different. I am offering consultation service in hematology and oncology, and the patients are scattered throughout multiple units and floors. Logging into different computers takes time. Consults appear unexpectedly, not on a set schedule. Secure chats never seem to stop. If I tried to complete every note immediately after every patient, I would spend much of my day walking back and forth and repeatedly logging into different computers. That is not efficient.

My inpatient workflow is designed around reality. Before I start the walking rounds, I review every patient’s chart, identify urgent issues and take care of them right away. I place the time-sensitive orders first. For example, if I see that a patient has a hemoglobin of 6 g/dL, I order a blood transfusion for that patient right away.

Then I start my rounds. I see patients primarily by geography, starting with the ICU of the sickest patients. I minimize unnecessary walking throughout the hospital. If I am familiar with the patients, I often see all 18-20 patients before returning to my computer.

Then I document. I return to one workstation. I complete my notes.  I enter the remaining orders efficiently while everything is still fresh. Instead of constantly switching between walking, charting, and logging into computers, I batch similar tasks together.

Expect interruptions, but do not let them control your day. Hospital medicine is unpredictable all the time. Consult requests arrive at any time. Secure chat messages appear. Questions come from nurses and other teams. Not everything deserves your immediate attention. Urgent issues should absolutely be addressed as soon as possible. Everything else can often wait until you have finished the task you are already doing. Every interruption has a cost. Protecting your attention allows you to finish your work more efficiently.

The bigger lesson is to design your workflow instead of letting it happen to you. This is not really about inpatient medicine. It is about being intentional. Your workflow should match your environment, your responsibilities, your patient population, and your team’s resources. What works in one setting may not work in another. And that is okay. The most efficient physicians are not rigid – they are flexible and adaptable.

Efficiency is a skill you can practice. Leaving work on time is not about working faster. It is about designing systems that reduce unnecessary work. Whether you are in clinic or on the hospital service, ask yourself: is my workflow helping me…or am I simply doing things the way I have always done them? Small adjustments, practiced consistently, can save hours over the course of a week. If you are tired of staying late every evening, there is another way. You do not need to become a different physician. Sometimes you simply need a workflow that is designed for the work you are doing.

If you are ready to reclaim your evenings and enjoy practicing medicine again, I would love to help. Learn more about my 1:1 Physician Coaching Program and discover how small workflow changes can create lasting freedom.